Vesicoureteral reflux: practical aspects of evaluation and management

The efficacy of both medical and surgical therapy for vesicoureteral reflux (VUR) has been well established. Controversy remains, however, regarding who should be evaluated for the presence of VUR, who should undergo corrective surgery, who should be treated medically and for how long. Medical treatment requires many years of continuous antibiotic prophylaxis, so compliance with therapy is essential. Many children are lost to followup, however, and remain untreated after a medical regimen is started. This large number of untreated children raises issues of the appropriateness of blanket therapeutic recommendations for all children with VUR and challenges the clinician to devise more effective treatment strategies.