Opinion - What is the normal prevalence of vesicoureteral reflux?

Background. The prevalence of vesicoureteral reflux in normal children has been estimated to be 0.4 % to 1.8 %. Based on epidemiological data, it can be estimated that 2.2 % of girls and 0.6 % of boys may be found to have reflux as a result of the investigation of urinary tract infection. This implies that most children with reflux will develop urinary tract infection. However, most children with reflux detected by screening do not develop infection. Hence the prevalence of vesicoureteral reflux in normal children may be higher than the previous estimates. Objective. To determine the prevalence of vesicoureteral reflux in groups of children with different clinical indications for cystogram. Materials and methods. Over 250 articles from the literature were re-viewed to determine the prevalence of vesicoureteral reflux in children undergoing cystogram. Means and 95 % confidence limits were derived from the data in studies that met the inclusion criteria. Results. The prevalence of vesicoureteral reflux in children with urinary tract infection was 31.1 % (95 % CI: 29.9-32.8). The prevalence of vesicoureteral reflux varied between patient groups, but often approached or exceeded the prevalence in urinary tract infection. The prevalence in normal kidneys was 17.2 % (95 % CI: 14.4-20.1). Conclusion. Vesicoureteral reflux is common in nearly all patient groups examined. The prevalence of vesicoureteral reflux in normal children is probably significantly higher than the traditional estimates.