Early recognition, adequate treatment, close observation, and systematic follow-up over a long period are essential to renal salvage in the child with vesicoureteral reflux. The decision whether and when to operate is made on a balance of factors by the pediatrician-urologist team. Among 236 patients with reflux diagnosed during childhood, reflux was stopped in 55 per cent of those treated medically and in 98 per cent of the more severe cases who were treated by ureteral reimplantation. Chronic pyelonephritis appeared or worsened during medical management in 12 per cent; no child showed new pyelonephritic scars or worsening of pyelonephritis after ureteral reimplantation.
It is practical to organize the management of urinary tract infections in children according to whether the infection is “serious” or “not serious.” A simple basis for this classification is the location of the infection in the urinary tract. Delay in recognizing serious disease may permit renal crippling. Where serious disease is suspected, the first goal is to determine the status of the urinary tract as a whole. The likelihood of functional success from modern urosurgical correction of abnormalities exceeds 90 to 95 per cent, whether treatment is medical or surgical. Cautious observation for years is essential.
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