Abstract
In 2010, AUA (American Urological Association) revised VUR guideline after more than 10-year interval. Although the guideline was initially supposed not so practical as had been expected, it clearly demonstrated that evidence is still lacking in recent clinical approach to primary VUR. Relevant issues such as CAKUT concept, urodynamics, prenatal diagnosis, and RI study, have been evolving and strongly influenced the approach. One might be able to say that VUR is a medical disease rather than surgical one. At present, large scale RCT has been progressing in north America for the purpose of documenting significance of continuous antibiotic prophylaxis. In young childhood, particularly in girls, voiding dysfunction has been shown to be related deeply and contributory to primary VUR for which medical approach including voiding instruction is essential. Of course, there are special cases with grade 5 VUR for which anti-reflux surgery is mandatory, but such cases are not common. High grade VUR has also been shown not exceptional to spontaneous resolution after as long as 10-year follow-up. However, if not resolved, persistent VUR bears a risk for UTI recurrence in women, especially later in pregnancy. The introduction of endoscopic injection therapy has provided good opportunity for us to decrease invasiveness of anti-reflux surgery. However, long term result after more than 3 years is still unknown. In this review article, the true character of primary VUR is investigated and optimal approach is discussed as well.
