The management of vesicoureteric reflux.

An increasingly large volume of data is being accumulated regarding the effects of vesicoureteric reflux on the kidney, data that influence clinical management. Although concrete guidelines cannot be drawn that will apply to all patients, important considerations include the following: All children with documented urinary infections should have a voiding cystourethrogram. The voiding cystourethrogram may correlate with probability of spontaneous resolution of vesicoureteric reflux. Younger patients have a higher chance of spontaneous resolution of vesicoureteric reflux. There is a definite familial tendency to vesicoureteric reflux, and patients with significant vesicoureteric reflux and scarring are more likely to have affected siblings. DMSA renal scanning is highly sensitive in the detection of scarring. Cystoscopy may play a role in the evaluation of the refluxing ureterovesical junction, but does not have as much prognostic significance as the voiding cystourethrogram. Urodynamic investigation may be important in evaluating children with urinary infections, reflux, and symptoms of voiding dysfunction. High-grade vesicoureteric reflux is associated with an increased incidence of renal scarring, and the answer to optimal management is not yet available. Most scarring occurs in infancy or childhood. Nonoperative management, especially in moderate degrees of reflux, can achieve a high rate of success. Nonoperative management requires continuous antibiotic prophylaxis. Breakthrough infections or lack of compliance with nonsurgical management have a high complication rate and must be managed aggressively. Antireflux surgery can be performed with a minimal complication rate.(ABSTRACT TRUNCATED AT 250 WORDS)