Introduction
Vesicoureteral reflux(VUR) is the non-physiologic retrograde flow of
urine from the bladder to the kidneys in children which can lead to
pyelonephritis and secondary renal injury due to renal scarring [1].
Though it is a common urogenital abnormality in children with the
prevalence of 0.4-1.8%, every stage of management of VUR is still under
debate [2]. The clinical management of reflux includes
observational, medical and surgical therapies. The surgical correction
of reflux has been the mainstay approach in high grade reflux but
generally it is not the sole objective of management considering the
aims of treatment: to avoid the occurrence of urinary tract infections
(UTI) and to avoid development of new renal scars [3]. Also the
benefit and necessity of antibiotic prophylaxis in low grade reflux are
under debate. Thus, management should be individualized and based on
each patient’s age, gender, grade of reflux, presence of renal scar,
clinical course, bilaterality, ipsilateral renal function, bladder
dysfunction (related lower urinary tract symptoms (LUTS) such as
urgency, urge incontinence, weak stream, hesitancy, frequency) and
parental preference [4]. Patients who have both VUR and lower
urinary tract dysfunction (LUTD) may have elevated risk of kidney damage
and worse outcome after treatment [5]. If LUTD is detected in a
reflux patient, it should be treated initially regardless choice of
treatment method.
The “European Association of Urology (EAU) Guidelines on Vesicoureteral
Reflux in Children (September 2012)” created a modified risk
classification by analyzing and defining risk factors such as age, sex,
reflux grade, LUTD, anatomic abnormalities, and kidney status for each
patient. They grouped patients into three groups according to the risk
classification and made recommendations for each group based on early
risk assessment. The authors aimed to identify cases requiring immediate
intervention or to avoid overtreatment in the spontaneous resolution
expected patients or only requiring conservative therapy [6]. We
hypothesized that the publication of guidelines altered the initial
management approach to patients with VUR. Therefore, we designed a
multicenter retrospective study to investigate the current trends in
initial management of reflux with respect to EAU guidelines and their
effect on results of treatments in our country. As a secondary outcome,
this study tried to highlight the preoperative determinants of
postoperative success rates of VUR correction techniques; either
endoscopic treatment or open reimplantation.