The Outcome of Surgery versus Medical Management in the Treatment of Vesicoureteral Reflux

Abstract

Evaluation of the relative merits of medical versus surgical management of vesicoureteral reflux (VUR) has been limited by the few prospective studies comparing these strategies. Among those trials that have been reported, the only consistent positive finding has been that incidence of febrile UTI is lower among children undergoing surgical treatment in comparison with medical treatment. Studies have not found significant differences in overall incidence of UTI, or in rates of new renal scarring or progression of existing scarring. It is likely that there is a subset of children with VUR who do benefit from aggressive treatment of their VUR, but we are not yet able to fully determine which children these are. It is hoped that future research will further clarify which treatments are useful in which children.

Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective

“…Surgical intervention indications are usually according to the previously reported guidelines [1,19,20]. The rate of surgical intervention in high-grade VUR patients was reported between 36% and 81% [3,[7][8][9][21][22][23][24][25][26]. Surgical correction was necessary for breakthrough UTIs or persistent VUR in 50-89% of cases according to the VUR index score [24].…”

“…Likewise, patients with high-grade VUR detected early in life are more likely to undergo surgical correction [ 24 ]. Anti-reflux surgery aims to block the abnormal ascent of urine and bladder infection to the upper tract by reconfiguring the anatomy of the uretero-vesical junction [ 16 , 19 , 25 ]. Surgical intervention was indicated in 81.5% of our patients due to repeated breakthrough febrile UTIs, deterioration of renal function, or persistence of high-grade VUR.…”

Management and Outcome of Vesicoureteral Reflux: A 14-Year Experience

“…Nelson mentioned that although there are patients with VUR who have positive results from surgical management, it is unclear which ones and with what criteria they are (6).…”