Variations in practice among urologists and nephrologists treating children with vesicoureteral reflux

J. S. Elder, H. M. Snyder, Craig A Peters, B. Arant, C. E. Hawtrey, R. S. Hurwitz, T. S. Parrott, R. A. Weiss

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


To analyze the current management recommendations among physicians treating children with vesicoureteral reflux, the American Urological Association Reflux Practice Guidelines Panel surveyed 100 pediatric urologists, 100 general urologists and 100 pediatric nephrologists by questionnaire, and received a 60% response. In the evaluation of a 4-year-old girl with bilateral grade 2 reflux general urologists were more likely than the other 2 groups to recommend cystoscopy and urethral dilation. At followup nuclear cystography was recommended by 76% of pediatric urologists, 48% of general urologists and 71% of pediatric nephrologists, while the latter 2 groups were less likely to recommend any subsequent upper tract evaluation. Pediatric urologists were significantly more likely to recommend antireflux surgery if the child had 1 breakthrough febrile urinary tract infection, poor compliance with medical management or persistent reflux at age 11 years. In a 6-year-old girl with unilateral grade 4 reflux and detrusor instability 44% of pediatric urologists recommended antimicrobial prophylaxis and anticholinergic therapy compared to 12% of general urologists and 6% of pediatric nephrologists. Antireflux surgery was recommended by 29% of pediatric urologists, 60% of general urologists and 59% of pediatric nephrologists. In older girls with persistent grade 2 or 3 reflux pediatric urologists were much more likely to recommend antireflux surgery. In contrast, they were less likely to recommend surgery in young girls and boys with newly diagnosed grade 4 reflux. These data demonstrate significant differences in therapeutic recommendations among pediatric urologists, general urologists and pediatric nephrologists, and suggest the need for outcomes research to determine the optimal management of children with vesicoureteral reflux.

Original languageEnglish (US)
Pages (from-to)714-717
Number of pages4
JournalJournal of Urology
Issue number2 II
StatePublished - Jan 1 1992


  • pyelonephritis
  • treatment protocols
  • urinary incontinence
  • urinary tract infections
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology


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