[Surgical treatment of vesicoureteral reflux in the first year of life?].

Surgical intervention in children with VUR is rarely indicated in the first year of life. Early surgical intervention is primarily required for male infants with a high-grade reflux, renal impairment due to reflux nephropathy, infravesical obstruction and breakthrough infections like pyelonephritis or urosepsis. Besides the recommended circumcision, this is usually limited to endoscopic infravesical disobstruction of posterior urethral valves, prolapsing ureteroceles or secondary bladder neck obstructions. Concomitant endoscopic reflux therapy with bulking agents such as hyaluronic acid/dextranomer should be regarded as a downstaging of the VUR; the decision should be made on an individual basis. Urinary diversion, e. g. vesicostomy or ureterocutaneostomy, is only required in exceptional cases.