Childhood urinary infection associated with vesico-ureteric reflux.

Among 222 children investigated in hospital for urinary infection 98 had vesicoureteric reflux only, and of these a group of 59 has been followed at a special clinic for from three to 14 years (mean 5.4 years). Children with reflux had an earlier age of onset and a greater likelihood of a family history of urinary infection than those with other diagnoses. Fifty-five were conservatively treated, and more than half of these still had reflux at the end of the study. Children with severe grades of reflux and an early onset of symptoms had least chance of reacting favourably to medical treatment. Evidence of renal deterioration was exceptional and virtually confined to the pre-school age group. It is argued that severe grades of reflux in pre-school children should be treated surgically, and that voiding cystograms need only be part of routine investigation in two circumstances, namely when the patient is under five, and on the very rare occasion when an older child shows progressive renal damage in serial pyelograms.