UROLOGY The Practical Management of Vesicoureteral

Early recognition, adequate treatment, close observation, and systematic follow-up over a long period are essential to renal salvage in the child with vesicoureteral reflux. The decision whether and when to operate is made on a balance of factors by the pediatrician-urologist team. Among 236 patients with reflux diagnosed during childhood, reflux was stopped in 55 per cent of those treated medically and in 98 per cent of the more severe cases who were treated by ureteral reimplantation. Chronic pyelonephritis appeared or worsened during medical management in 12 per cent; no child showed new pyelonephritic scars or worsening of pyelonephritis after ureteral re-implantation. N MOST MEDICAL CENTERS, children with recurrent urinary tract infection or urographic changes of pyelonephritis, or both, are investigated for vesicoureteral reflux. This condition derives its importanc