Vasicoureteral reflux in children: Surgical or nonsurgical management

Hippokratia 2002, 6(3):118-122

G. Kasselas, G. Tsikopoulos


Since the beginning of the 20th century it has been well known that one of the most common causes of urinary track disease in childhood is Vesicoureteral Reflux (VUR). Normally there is a valvular mechanism which does not permit reflux of urine from bladder to ureters during voiding. The single most important factor in maintaining this one-way characteristic of the ureterovesical function is the occlusion of the ureteral lumen as the increase in intravesical pressure compresses it against the defrusor muscle. If, for any reason (congenital or acquired), this valvular mechanism is disturbed, vesicoureteral reflux becomes apparent. Technological progress and prenatal diagnosis have offered much to the evaluation and treatment of the disease the last years. Today surgical treatment of VUR by means of ureteral reimplantation in the bladder wall is recommended only in severe, persistent cases with recurrent urinary infections and renal scarring despite antibiotic therapy. Having good knowledge of the clinical symptomatology and the consequences in renal function, most children receive proper antibiotic chemoprophylaxis as the treatment of choice. In case that conservative treatment fails to improve the situation we proceed to surgical treatment as a definite treatment. The argument that still exists between pediatric surgeons, pediatricians, pediatric nephrologists and pediatric urologists, concerns the disagreement between conservative and surgical treatment. If we accept as an undoubtful fact that VUR is not a single pathology but a complicated urodynamic phenomenon that in its initial appearance may be a transient stage to disease and destruction of renal parenchyma, then we believe that all of us agree about the pattern of treatment and management of the disease.