Introduction: Vesicoureteral reflux (VUR) was historically believed to inevitably result in pyelonephritis, scarring, and renal insufficiency, which resulted in aggressive investigations and surgical treatment. However, over the past 20 years, spontaneous resolution has been expected and prophylactic antibiotics and treatment of bowel and bladder dysfunction have had a greater efficacy at reducing urinary tract infection rates than surgery. Therefore, treatment has been aimed at minimizing morbidity of the investigations (voiding cystourethrogram [VCUG]: catheterization and radiation) without sacrificing treatment of significant disease. We hypothesized that fewer VCUGs are being performed, with an increased proportion of positive tests and higher grades. We also believe that rates of surgical intervention and renal damage will remain stable.

Methods: A retrospective review was undertaken to determine the number and results of VCUGs performed over the past 20 years, surveying data from 2005, 2010, 2015, and 2010. The number of surgeries is also reported, combining open reimplant and endoscopic repairs.

Results: A total of 614 VCUGs were performed in 2005, 697 in 2010, 404 in 2015, and 208 in 2020. Rates of a positive exam for VUR were 34%, 26%, 29%, and 32%, respectively. The number of patients with bilateral VUR was: 79 (15%), 78 (13%), 79 (19%), and 40 (19%), respectively.  The number of patients with high-grade (IV and V) was: 14 (3%), 13 (3%), 20 (5%), and 14 (7%), respectively.  The number of anti-reflux surgeries performed for the years 2010, 2015, and 2020 was 28, 10, and 8, respectively. We have been able to show that the number of VCUGs performed dropped by almost 1/3 in 2015 and 2/3 in 2020.  The rates of bilateral VUR and high-grade reflux increased.  The numbers of surgeries performed decreased over the reporting period.  Renal outcome data is pending.  

Conclusions: Contemporary guidelines have resulted in a decrease in investigations and treatment of VUR.