Disappearance of vesicoureteral reflux in children

Objective: To describe the disappearance of reflux in children with vesicoureteral reflux, in whom there are presently no population-based long-term studies. Design: An unselected cohort of children with reflux detected after their first known symptomatic urinary tract infection was followed up prospectively for up to 15 years. Setting: A single children's hospital in a distinct geographical area at which most children with symptomatic urinary tract infection were treated. Patients: Two hundred thirty children-173 girls and 57 boys-with unilateral (n=130) and bilateral (n=100) reflux. Dilated reflux (grades III-V) was found in 54 patients (23.5%). The frequency of reflux was 34% in girls and 31% in boys who were examined after urinary tract infection. Main Outcome Measure: Disappearance of reflux. Results: The probability of spontaneous disappearance of reflux was estimated using Kaplan-Meier survival curves based on 164 children who underwent multiple voiding cystourethrographies. There was a marked tendency for disappearance of reflux, with 73% of children with dilated reflux having no or only grade I reflux after 10 years. Shorter persistence of reflux was found in children with undilated reflux at the initial investigation and in boys compared with girls. However, age at first investigation was not related to the rate of disappearance, and there was no difference between children with bilateral compared with unilateral reflux. Conclusions: This study of an unselected group of children with urinary tract infection shows a favorable longterm outcome concerning disappearance of reflux. In children with dilated reflux, this tendency was more pronounced than previously reported.