Incidence of  vesicoureteral reflux (VUR) as low as <1% and as high as 1-2% of general population.

VUR seen in 25-40% of children evaluated for acute pyelonephritis.

VUR seen in 5-50% of asymptomatic siblings of children with documented reflux.

Females>>males

 International Reflux Study Committee grading system (See the figure) 

      Vesicoureteral reflux has traditionally been treated with reimplantation of the ureters creating a longer tract through the wall of the bladder so that the pressure of the detrusor muscle against the ureter during bladder filling will prevent reflux.   

  In recent years a newer method has been the injection of various material to create a deformity in the ureter as it passes through the wall. 

The most recent material is a dextranomer/ Hyaluronic acid copolymer called Deflux.

     Spontaneous resolution of reflux is high especially in younger children with lower grades of reflux, but can occur even in higher grades if patients are successfully treated with antibiotics.    

  In those who require intervention, Deflux results in an overall cure rate of about 80%, but may require up to 3 injections.

Complication rates are low, including transient obstruction and infection.

The alternative is ureteral reimplantation with complication rates of about 1% including organ damage, obstruction, continued reflux, and bleeding.    

 Imaging often initially shows the echogenic material in the wall initially, but may diminish over time.

Long term followup studies on these patients have not yet occurred.

This procedure was approved by the FDA for use in the United States in 2001. 

 TAKE HOME MESSAGE:80% outgrow VUR before puberty.