Renal growth in children with severe vesicoureteral reflux: 10-year prospective study of medical and surgical treatment - The international reflux study in children (European branch)

PURPOSE: To determine whether medical or surgical treatment better promotes renal growth in children with severe vesicoureteric reflux (VUR) and to ex amine factors influencing renal growth. MATERIALS AND METHODS: Three hundred two children younger than 11 years wit h urinary tract infection and grade III or IV VUR were randomly assigned to surgical (n = 149) or medical (n = 153) treatment and were followed up at serial intravenous urography for up to 5 years; 223, for up to 10 years (su rgical, n = 110; medical, n = 113). Renal size was measured planimetrically on serial intravenous urograms and was related to the virtual height of L1 through L3 by expressing it as an SD score. RESULTS: There was no significant difference in mean renal growth between p atients treated surgically or those treated medically after 5- or 10-year f ollow-up. Bilateral renal size of 80 surgical and 75 medical patients remai ned within 1 SD score. In patients entering the study at 2 years of age or younger and in those with grade IV VUR, bilateral VUR, or renal scars, ther e was a trend toward improved renal growth in those treated medically, but this finding was not statistically significant. When renal scarring or thin parenchyma was unilateral, the affected kidney grew less well, irrespectiv e of treatment. Bilateral renal scarring was usually asymmetrical, with a c orresponding effect on renal growth. CONCLUSION: There was no significant difference in renal growth during 10 y ears between surgical and medical treatment in patients with severe reflux.