[Vesico-uretral reflux--surgical or conservative management? (author's transl)]

The dangers of VUR for structure and function of renal parenchyma and for blood pressure are described together with factors determining the individual risk for the patient. For the conservative management only continuous antibiotic prophylaxis combined with early and intense antibiotic treatment can be approved as appropriate today. For surgical management, the methods described by Lich-Gregoir and Politano-Leadbetter have stood the test of time. the prevalence of post-surgical persistance of VUR and of post-surgical obstruction for those reflux grades for which today a primary operation would be acceptable, is between 5 and 10%. The primary conservative management is adequate particularly for children with non-dilating reflux, whereas primary surgical management is preferred by most in children with gross reflux (grade V). For moderate reflux grades III and IV) it is unknown whether non-surgical or surgical management gives the better results. Only a prospective clinical study comparing surgical and non-surgical management can answer thus urgent question.