Endoscopic Treatment of Primary Vesicoureteral Reflux

A 7-year-old girl with a history of recurrent urinary tract infection since the age of 3 years is known to have bilateral, moderately severe (grade III) vesicoureteral reflux. Renal scintigraphy with technetium-99-labeled dimercaptosuccinic acid has revealed bilateral scarring in the upper poles of her kidneys, with more severe scarring on the left kidney than on the right. Despite ongoing antimicrobial prophylaxis, she has recently had another febrile urinary tract infection, which responded well to antibiotic treatment. Radionuclide cystography reveals persistent bilateral, moderately severe vesicoureteral reflux. The patient has no history of constipation or dysfunctional voiding. She is referred to a pediatric urologist, who discusses with the patient and her parents the various treatment options, including endoscopic correction.