Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux: two years' observation in 96 children.

Children with severe vesicoureteric reflux were allocated at random within three age groups (less than 1, 1-5, and greater than or equal to 6 years) to either operative or non-operative treatment. In 96 children who completed two years' observation there was no significant difference between treatment groups in either the incidence of breakthrough urinary tract infection, slope clearance of 51Cr-edetic acid, renal length, new scar formation, or progression of existing scars. Ureteric reimplantation was technically successful in 97% of cases, whereas 74% of ureters managed non-operatively still showed significant reflux at two years. No short term advantage was shown for either form of treatment in this series, but the long term effects of persistent, severe vesicoureteric reflux require further study. The prevention of reflux nephropathy probably demands the identification of vesicoureteric reflux before the advent of urinary tract infection, a goal not attainable with present invasive techniques.