A new insight into the management of high-grade vesicoureteral reflux

Introduction
High-grade vesicoureteral reflux (VUR) is a major dilemma to urologists, with no clear time for intervention in children without evidence of urinary tract infection. The aim of our study was to show our experience in managing high-grade VUR in children with high postvoiding residual.

Material and methods
Our study included 24 children with high-grade reflux persistent while being on surveillance and continuous antibiotic prophylaxis. Besides radiological investigations, 24-hour urine output and postvoiding residual were our main clinical parameters to study.

Results
All the children with high-grade reflux in our study were found to have polyuria and high postvoiding residual. Surgical correction was done through open surgical ureteral reimplantation combined with the use of vasopressin. Reduction cystoplasty was done for 2 children. One-year follow-up showed satisfactory outcomes in reducing bladder capacity and treating reflux.

Conclusions
Children with high-grade VUR should be assessed for polyuria. The presence of polyuria should be an indication for early surgical management.