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.
Highlights
Urinary tract infection (UTI) is one of the most common serious bacterial infections in children
Since these management strategies are based on assumptions about the pathophysiology of UTI, vesicoureteral reflux (VUR), and renal scarring, if such assumptions are incorrect it should not surprise us that our interventions seem to have little or no effect
The Smellie group made seminal observations regarding the associations between VUR, UTI, and negative renal outcomes including scarring and decreased renal growth, and developed hypotheses regarding the apparent benefits of antimicrobial prophylaxis in children with VUR
Summary
Urinary tract infection (UTI) is one of the most common serious bacterial infections in children. Antireflux surgery (ARS), in contrast, reconfigures the ureterovesical junction anatomy to block access to the upper tracts, so that any episodes of cystitis that do occur cannot progress to pyelonephritis. This model has been called into question in recent years by data that challenges many of the assumptions of the VUR paradigm. As we will see below, it has been difficult to demonstrate that current management strategies for VUR result in measurably improved outcomes Since these management strategies are based on assumptions about the pathophysiology of UTI, VUR, and renal scarring, if such assumptions are incorrect it should not surprise us that our interventions seem to have little or no effect
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