Treatment of vesico-ureteric reflux in children.

Approximately 35% of children with urinary infection have vesico-ureteric reflux (McGovern, Marshall, and Paquin, 1960; Ericsson, 1960). It is not known whether infection causes the reflux by damaging the uretero-vesical valvular mechanism, or whether a congenital abnormality permits reflux which predisposes to infection. Yet whatever the aetiology, it seems logical to assume that when infection occurs in the presence of reflux there will be renal involvement, for it has been shown that there is a close correlation between ureteric reflux and radiological evidence ofkidney scarring (Hodson and Edwards, 1960). Despite this, it is not clear whether, besides treating the infection by giving prolonged carefully controlled courses of antibiotics, the child will gain additional benefit if a surgical operation is undertaken to eliminate the reflux. The purpose of this paper is to report the results of a controlled trial in which a group of children with surgically treated reflux was compared with an unoperated group. The trial was a prospective one and the children were allotted at random to either the operated or control groups according to whether their birthdays fell on even or odd days. In view of the considerable divergence of opinion about the value of the surgical treatment of reflux (Spence et al., 1961) and the uncomplicated nature of this type of surgery, it was felt that it was ethically justifiable to conduct a trial in this manner. 58 children were studied, 33 having operations for their reflux and 25 acting as controls. Cases in which reflux was associated either with mechanical obstruction in the urethra, such as posterior urethral valves, or with neurogenic bladder, were excluded from the trial, as it was felt that in these the treatment of the reflux could not be considered in isolation but only as a part of the management of the associated condition.