Natural history of vesicoureteral reflux in girls after age 5 years

Purpose: Expectations concerning the likelihood that vesicoureteral reflux will resolve during a given interval are predominantly based on experience with children younger than 5 years. We assess the natural course of vesicou reteral reflux in girls older than 5 years. Materials and Methods: We reviewed the diagnostic and followup cystograms, medical records and renal imaging studies of 200 girls with vesicoureteral reflux, of whom 97 were diagnosed before age 60 months and 103 were diagnos ed at or after age 60 months. Vesicoureteral reflux was considered to have resolved when a followup radionuclide cystogram demonstrated no reflux. Results: Vesicoureteral reflux demonstrated at or after age 60 months by a radionuclide or radiographic examination (index study) resolved in 43% of c ases during a mean followup interval of 41 months. The yearly percent chanc e of resolution approached or exceeded 20% through age 11 years. For girls with moderate vesicoureteral reflux on the index study unilateral moderate vesicoureteral reflux was associated with a higher overall percent chance o f resolution and a shorter time from index study to resolution. Evidence of new or progressive parenchymal injury was not indicated in any of 92 girls who underwent serial renal ultrasonograms. Conclusions: Vesicoureteral reflux resolution continues after age 5 years a t a rate similar to that in younger children. Continued medical management in the anticipation of spontaneous resolution is safe and appropriate for m ost patients.