Primary vesicoureteral reflux: conservative therapy or surgical intervention

Abstract

Patients with low grade vesicoureteral reflux and recurring urinary tract infections tend to experience spontaneous reflux resolution with good renal evolution in the long term in a way that surgical intervention becomes limited to high grade reflux or when followed by other clinical issues.

Primary Bilateral High-Grade Vesicoureteral Reflux in Children: Management Perspective

“…In the study of Alvarez et al (2018) [26], the percentage of patients with high-grade VUR who underwent surgery was higher (81.25%) than those with low-intermediate grade VUR (18.75%). Teixeira et al stated that patients with renal scarring were predominantly referred to surgical correction and most of our patients had renal scarring at initial DMSA scans [7].…”

“…Surgical intervention indications are usually according to the previously reported guidelines [1,19,20]. The rate of surgical intervention in high-grade VUR patients was reported between 36% and 81% [3,[7][8][9][21][22][23][24][25][26]. Surgical correction was necessary for breakthrough UTIs or persistent VUR in 50-89% of cases according to the VUR index score [24].…”

“…VUR is classified into primary or secondary according to the underlying etiology and unilateral or bilateral according to the affected side [4]. The actual incidence of bilateral VUR is not clear, however, it ranges from 30% to 58% of all children with VUR in the current literature [2,[5][6][7][8][9].…”

“…Patient compliance plays a crucial role in this therapeutic option and, the patient's parent or guardian needs to understand that compliance is the cornerstone throughout the therapeutic journey of their child. On the other hand, patients on prophylactic antibiotics might experience some side effects 8-10% of the time, which can dramatically affect their compliance [7].…”

Management and Outcome of Vesicoureteral Reflux: A 14-Year Experience

“…According to recent meta-analyses, it is uncertain whether renal scarring or end-stage renal disease (ESRD) can be prevented with the treatment of VUR (1,2). Borges Bezerra Teixeira and colleagues study showed no relation between VUR grade and the presence of renal scarring (3).…”