Medical or surgical management for children with vesico-ureteric reflux?

A critical survey of the literature on treatment of children with vesico-ur eteric reflux was carried out in order to create a basis for the new Swedis h management policy. There are few studies that meet modem standards of sci entific methodology and provide adequate patient numbers. The only large in vestigations that randomized patients to operative or non-operative treatme nt were the Birmingham Reflux Study and the International Reflux Study in C hildren. In these studies, longterm outcome of renal status and renal funct ion, as well as the number of recurrent infections, were independent of tre atment modality. Although pyelonephritic recurrences were less common in th e surgically managed group, this did not influence appearance of renal dama ge. There is no evidence to indicate clear superiority of either medical or surgical management. Further studies are needed to address such questions as the optimal duration of antibacterial prophylaxis and the effect of a di lating reflux that persists into adulthood.