Surgical treatment of vesicoureteric reflux

Vesicoureteric reflux (VUR), the retrograde flow of urine from the bladder into the upper tracts, is a common finding during investigation of the urinary tract. It is a risk factor for urinary tract infection (UTI). The gold standard for diagnosis is a direct micturating cystourethrogram (MCUG). VUR may resolve spontaneously, and in recent years the trend has been towards conservative management to lower the risk of UTI. However, in some circumstances for example when conservative treatment fails, surgery may be required. Surgery for VUR is reliable at downgrading the extent of VUR, and lowers the frequency of UTI but probably does not influence the outcome of the kidneys. For this reason, patients and their families must be selected and counselled carefully. As with many surgical procedures there has been interest in minimal access although the fundamental principles of abolishing reflux remain the same. This article briefly reviews the roles of medical and surgical treatment in the management of VUR.