Resolution of vesicoureteral reflux in completely duplicated systems: fact or fiction?

A total of 60 patients (71 renal units) with grade 2/5 vesicoureteral reflux into the lower pole moiety of a completely duplicated system was managed by medical surveillance and is compared to an identically managed age, race and sex matched control population with a similar degree of reflux into a single collecting system. During a median 2-year observation period reflux ceased spontaneously in 10% of the patients with duplication compared to 35% of the control population (p less than 0.01). Comparisons between the 2 study groups failed to reveal a difference in the incidence of break-through urinary tract infections, advancing degrees of reflux and/or the development or progression of renal scarring (p greater than 0.5). Despite the fact that the resolution rate in duplex systems is significantly lower than that of a single system, it is apparent that cessation of grade 2/5 reflux into a duplicated ureter will occur and that a trial of medical management is an appropriate initial method of therapy.