Vesicoureteric Reflux

The consensus here is that the indirect radionuclide cystogram is the method of choice for follow-up of proven reflux in children who are old enough to cooperate. Because it cannot supply morphological imaging, it cannot exclude abnormal anatomy, especially posterior urethral valves in boys. Therefore it is felt that at least one structural study [micturating cystourethrography (MCUG), with or without urody-namics] should be performed at first presentation. The rationale for follow-up (often not clearly formulated) is that if there is persisting reflux-accompanied urinary tract infections, surgical correction is indicated and will prevent infections, scarring, and deterioration in renal function. It is also often felt necessary to give long-term antibiotic prophylaxis as long as reflux persists. This is based on the experimental work of Risdon and Ransley, which showed that pyelonephritis developed in the setting of reflux, infection, and compound calyces.

However, there are now several studies showing that there is no difference between the outcome, in terms of renal function, whether the children are treated medically or surgically. This has led to a view similar to that discussed above that vesicoureteric reflux is a marker of an abnormal nephrourological system, which may, in a small number of cases, progress to renal failure regardless of intervention. In this view, the demonstration of reflux identifies a urinary tract that is "at-risk."

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