7.4.1 Conservative therapy

The objective of conservative therapy is prevention of febrile UTIs. Along with an ample supply of liquid and regular complete voidance of the bladder (if necessary with double micturition), a good hygiene and a low dosage of prophylactic long-term antibiotics are central aspects of conservative therapy.

The assumption that in some patients VRR disappears without surgical intervention justifies a conservative approach. The chance of a spontaneous improvement only exists, however, for young patients with a low-grade reflux and without serious pathology of the ureteral orifices. If reflux persists up to an age in which spontaneous disappearance can no longer be expected, then girls should be submitted to operative reconstruction. In boys > 5 years, antibiotic prophylaxis may be stopped as the indication for reflux correction is rare. If febrile UTIs occur under antibiotic prophylaxis, the conservative strategy should be omitted and surgical intervention should be planned.