The management of ureteric reflux in children.
A series of 262 children suffering from vesico-ureteric reflux is presented. Nearly all presented with a urinary tract infection and the age at onset of symptoms was predominantly in the pre-school years. The reflux was not diagnosed in the majority until after the children started attending school. Over one-third had symptoms for more than half their lives before reflux was diagnosed. The incidence of hypertension and renal insufficiency in the series were 4% and 7-8% respectively. Nearly 60% of the children were selected by defined criteria for operation as their initial treatment. The remainder were treated conservatively in the first instance but 30% of these subsequently required operation. Reflux was eliminated in 96.3% of the children at the first operation and 5.5% developed postoperative ureteric dilatation, none of them permanently. Reflux disappeared spontaneously in two-thirds of the children treated conservatively but took more than 3 years in 46%. Infection recurred in 24% of children treated by operation and in 29% treated conservatively. The incidence with which reflux disappeared spontaneously in the children treated conservatively was related to time, not to the infection recurrence rate.