Vesico-ureteral reflux in children.

A total of 126 children with 193 refluxing renal units were treated for vesico-ureteral reflux during the period 1966-74. The grading of the cases into mild, moderate and severe reflux revealed renal scarring in 5, 22 and 28% of the three groups. Conservative treatment was used in 10% of the patients, surgery on the urethra in 25%, and reimplantation of the ureter by the Politano-Leadbetter technique in the last two-thirds of the patients. Reflux was eliminated in 50% of the renal units treated conservatively, in 60% of renal units treated with surgery on the urethra, and in 86% of units treated with reimplantation. The overall results seemed to be better in mild than in moderate or severe reflux. The dilatation of the upper urinary tract returned to or approached normal in 85%. Of the children, 80% were without symptoms postoperatively, whereas urinary-tract infection persisted in 36%. The value of the grading of reflux is emphasised, and indications for treatment are discussed.