[Non-surgical approach to the treatment of vesico-ureteral reflux in childhood].

The authors report about their point of view, based on their experience treating children with vesicoureteric reflux (VUR) in the last two decades. 812 children were treated for VUR between 1973-1992. In 62 (7.6%) due to the parenchymal damage, primary nephrectomy was made, antireflux operations were done in 227 (30.3%). Without surgery, recovery or significant improvement was achieved in 523 children (69.7%). The basis of the good results with conservative therapy is in their opinion the thorough knowledge of the function of the urinary organs, especially of the urinary tract, and the precise detection of the pathophysiological processes leading to VUR. The conditions in which antireflux surgery is avoided, are discussed in details, emphasizing the situations and methods eventually leading to mistakes, e. g. the improper judgement of VUR detected during acute pyelonephritis or during an incorrectly performed micturition cystography, and the undiagnosed damaged bladder function. Essential is therefore to clarify the etiology of the VUR and the compensated/uncompensated state of the urinary tract, the clinical condition of the child. Antireflux operation is necessary only if in the renal parenchymal damage the role of the VUR is obvious and it can be prevented only with surgery.