Editorial commentary. Pediatric vesicoureteral reflux.
If there were ever an anomaly that defined a specialty it would have to be that of vesicoureteral reflux and pediatric urology. As Sir David Innes Williams, considered by many to be the father of modern pediatric urology, once stated “The more we look for reflux, the more often we found it. This was the real launching point for pediatric urology. Here we had a prospect of a surgical operation curing a common complaint.” However it was not much later that Sir David became rather bored with vesicoureteral reflux as in 1974 responding to Stu Bauer he stated “Reflux is old hatnow that we have a reliable operation to fix it, it is a boring subject to talk about.” The work of Ransley and Risdon on reflux and papillary morphology taught us the potential risk of the combination of UTI and reflux. Since then there have been many swings of the pendulum. As trainees, many of us were taught that restoration of anatomy was the ultimate goal to prevent renal damage and most refluxers who did not resolve went on to surgical correction. In the 1980s and 1990s, there was data that was beginning to be accumulated in London and confirmed at other centers suggesting that renal function and, more importantly, renal anatomy at the time of diagnosis was a significant factor in determining which children with reflux were likely to resolve their reflux and which children with reflux were likely to go on to develop breakthrough upper tract infections and renal damage. Painted over that back drop in the 1990s came the long awaited endoscopic correction of reflux, the culmination of the work started by O’Donnell and Puri. This forced us to ask different questions about our refluxers. Finally atop all of this comes bladder and lower urinary tract dysfunction which is the hidden part of the iceberg. New and simple questions have now arisen, such as