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.