Anti-reflux surgery in infancy: contra

The current management of vesicoureteral reflux (VUR) in infants remains controversial. Parameters such as high spontaneous resolution rates even in high-grade reflux in up to 45 %, associated renal hypo-/dysplasia in boys in up to 30 % and immature bladder function characterise the condition in early life. In this context, the reflux per se has become less important. This makes it all the more surprising that endoscopic treatment is recommended in recent papers to eliminate or downgrade the reflux in infants as an alternative to conservative treatment regimes. Compared with antibiotic prophylaxis, there is no difference in outcomes regarding new episodes of urinary tract infections or renal scarring. On the other hand, the necessity of anaesthesia, considerable reflux recurrence rates and the risk of obstruction in the short and long-term follow-up must be taken into consideration. Minimally-invasive anti-reflux surgery techniques are feasible also in infants. However, in due consideration of the high spontaneous resolution rates of reflux during the first 12 to 15 months of life and the fact that bladder function is still immature at that age, they should not be used as routine interventions.