Three-phase cystoscopic inspection of vesicoureteral valve

Treatment of vesicoureteral reflux: point system based on twenty years of experience

Five hundred girls with recurrent urinary tract infections and documented reflux were seen in our private practice during the last twenty years. All patients received medical treatment for three to forty-eight months (an average of fifteen months) after which the 250 who were not cured were submitted to corrective surgery. The primary reason for antireflux surgery is to protect the kidney from the damaging effect of a combination of high pressure and infection. Thus our criteria for operation included persistent infection, renal changes typical of past pyelonephritis, major reflux, and abdominal or flank pain. Our surgical cure rate after careful long-term follow-up is 96%. Our medical-surgical cure rate at the end of two years reached 88%. This experience has enabled us to evolve a rigorous point system providing common denominators regardind indications for operation. It emphasizes the desirability of attempting a medical cure for at least one year after urethral dilatation, except where major orifice defects and major reflux exist. This system should help to increase communication and coordination of efforts between pediatrician, radiologist, and urologist.