Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial

Lancet. 2001 Apr 28;357(9265):1329-33. doi: 10.1016/S0140-6736(00)04520-7.


Background: Nephropathy associated with vesicoureteric reflux (VUR) and urinary tract infection can result in end-stage renal failure, hypertension, or both. Whether long-term VUR contributes to these outcomes is unknown. We compared, in a randomised trial, medical with surgical management of children with bilateral severe VUR and bilateral nephropathy.

Methods: We stratified by age and glomerular filtration rate (GFR) 25 boys and 27 girls aged 1-12 years and randomly assigned them to medical or surgical management. At enrolment and 4 years' follow-up we estimated GFR from the plasma clearance of 51Cr-labelled edetic acid (EDTA), and did intravenous urography. We also did a metastable 99mTc-labelled dimercaptosuccinic acid (DMSA) assay and contrast cystography. The change in GFR at 4 years, expressed as a percentage change between enrolment and 4 years, was available for 26 of 27 patients in the medical and 24 of 25 in the surgical group. We assessed GFR in 48 patients 10 years after enrolment.

Findings: Mean GFR at enrolment was 72.4 mL/min per 1.73 m(2) (SD 24.1) in the medical and 71.7 mL/min per 1.73 m(2) (22.6) in the surgical group. The mean percentage change in GFR at 4 years was 2.4% (SE 4.5) versus 4.7% (5.0) in the medical and surgical groups, respectively. The difference in change in GFR at 4 years between the two groups was not significant (7.1%, 95% CI 6.4% to 20.6%).

Interpretation: Our data do not lend support to the view that the outcome for renal function is improved by surgical correction of VUR in children with bilateral disease.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents
  • Antibiotic Prophylaxis*
  • Child
  • Child, Preschool
  • Confidence Intervals
  • Drug Therapy, Combination / therapeutic use
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Infant
  • Kidney / pathology
  • Male
  • Pyelonephritis / drug therapy
  • Pyelonephritis / etiology
  • Treatment Outcome
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / etiology
  • Urography
  • Vesico-Ureteral Reflux / complications
  • Vesico-Ureteral Reflux / drug therapy*
  • Vesico-Ureteral Reflux / surgery*


  • Anti-Bacterial Agents