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Treatment of vesicoureteric reflux. Results of a prospective study
1Department of Paediatric Urology, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
Insights
For children with vesicoureteric reflux (VUR), antibiotic treatment is effective for low grades (I-III). Surgery is recommended for higher grades (IV-V) to ensure successful outcomes.
Area of Science:
- Pediatric Urology
- Nephrology
Background:
- Vesicoureteric reflux (VUR) is a common condition in children.
- Management strategies for VUR vary based on reflux grade.
Purpose of the Study:
- To evaluate the efficacy of different management strategies for non-obstructive VUR in children.
- To compare conservative (antibiotic) versus surgical treatment for various VUR grades.
Main Methods:
- Prospective study of 93 children (135 refluxing ureters) followed for at least 5 years.
- Initial treatment based on VUR grade: antibiotics for grades I-III, randomization for grade IV (antibiotics vs. surgery), reimplantation for grade V.
- Outcomes assessed included reflux resolution and ureteric obstruction.
Main Results:
- Antibiotic treatment alone resolved reflux in 64/85 ureters (grades I-III) and reduced it in 12.
- Surgery (reimplantation) cured reflux in 46/50 ureters (grade V) without severe obstruction.
- Conservative management was less successful for grade IV VUR compared to surgery.
Conclusions:
- Conservative, non-surgical management is satisfactory for low-grade VUR (I-III).
- Surgery is the preferred treatment for high-grade VUR (IV-V), provided detrusor instability is excluded.
Abstract:
Between 1982 and 1986, 96 children with non-obstructive vesicoureteric reflux were included in a prospective study. Three patients withdrew from the study and results are therefore presented on 93 children with 135 refluxing ureters who were followed up for at least 5 years. Initially, all children with reflux grade III or less received antibiotic treatment only. Those with reflux grade IV were randomised to antibiotic treatment alone versus surgery plus antibiotic treatment; the primary treatment of reflux grade V was reimplantation. In 85 ureters treated by antibiotics only, reflux disappeared in 64 cases and was reduced in 12. In 50 ureters treated by reimplantation, reflux was cured in 46 cases and no severe ureteric obstruction was seen. Conservative management of reflux grade IV was less successful than surgery. The results of conservative, non-surgical treatment of reflux grades I-III were satisfactory, but for grades IV and V surgery should be the treatment of choice if detrusor instability has been excluded.