Management of primary vesico-ureteric reflux in children--operation ineffective in preventing progressive renal damage.

Four studies comprising 606 children and with a follow-up of 4-5 years have shown that operation and long-term antibiotic prophylaxis are equally ineffective in preventing post-infectious, progressive renal damage in children with grade III-IV reflux. To consider only the grade of reflux in the choice of management is too simple an approach. Other aspects of the complex biology of UTI should also be considered. Another important aspect concerns the organization of the care. Efficient and robust routines for a thorough follow-up and measures to guarantee immediate diagnosis and treatment of recurrent infections in children known to be at risk may be more important for the preservation of the kidneys than a stereotyped policy of operation or "endless" antibiotic prophylaxis. Specialized teams should be used as in the treatment of other long-term diseases. Parents should be educated and made active participants in the supervision of children at risk. Controlled multicentre studies are powerful scientific instruments, but appear to have too little impact on clinical practice. The responsibility of clinical scientists to make important results known and understood among those concerned is discussed from the ethical point of view.