[A comparative study of the treatment of vesicoureteral reflux in childhood: a review of a series of 636 refluxing units].

A number of 411 pediatric patients (636 refluxing renal units) diagnosed as having vesicoureteral reflux (VUR) were evaluated in our Hospital between 1985 and 1997. All the patients were divided in two historic groups based on the therapeutical modalities employed. The children included in group A (between 1985 and 1995) were medically or surgically treated according to the grade of reflux. In the group B (between 1995 and 1997), the endoscopic treatment was added to previous. All cases underwent urine cultures, renal ultrasonography, voiding cystourethrography and isotopic gammagraphy with DMSA scan. In some patients were performed radionuclide renography with DTPA or MAG-3 to assess renal function. We consider that medical management is required in low grade reflux (I and II) but patients with high grade reflux (IV and V) clearly benefit from early ureteral surgical reimplantation (Cohen technique). In our series, patients with reflux grade III are treated endoscopically with Teflon or PDMS (polydimethylsiloxane) with resolution of reflux in 82-92% after first injection.