Vesicoureteric reflux (VUR) in children: where are we now?

In 1960 Hodson and Edwards published their landmark paper about the association between chronic pyelonefritis and vesicoureteric reflux (VUR). Since then, the approach for VUR became more important (1). In the last 30 years there have been multiple publications on vesicoureteric reflux (VUR) and discussions at Pediatric Urology meetings with the purpose to give answers to the questions what the best treatment is for VUR, at what age the treatment is advocated, does it prevent for febrile urinary tract infections (UTI's) and does it stop of decreases the risk for reflux nefropathy and renal scars Well known are the International Reflux Study (1981) with a European and an American arm in which the researchers compared medical approaches with surgical approaches to reflux, and the Birmingham Reflux study (1987) which was a prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children with five years observation (2). In 2009 the group from John Hopkins (Baltimore, USA) published their interim results from a randomized placebo-controlled study of children with VUR (the RIVUR Study) (3). The most recent randomized controlled trial (RCT) is the Swedish Reflux Trial published in the Journal of Urology 2010, July. This was set up as a RCT to compare 3 treatment alternatives, including antibiotic prophylaxis, endoscopic therapy and surveillance as the control group, in regard to recurrent febrile UTIs, renal damage and VUR status after 2 years (4). Since these new data are available, we want to give an update in this specific and interesting field in Pediatric Urology.