Opposition to VUR Surgery

Shin-Mei WongTaiwan Speaker Opposition to VUR SurgeryVesicoureteral reflux (VUR) is closely associated with urinary tract infections (UTIs) and renal scarring in neonates and children. Primary VUR attributes its pathogenesis to a congenitally short submucosal ureteral tunnel, resulting in inadequate ureterovesical junction resistance. This concept has informed the development of various surgical techniques aimed at increasing ureteral resistance. However, emerging evidence suggests that surgical correction does not consistently offer superior long-term renal outcomes compared to continuous antibiotic prophylaxis (CAP). This raises important concerns regarding the role of surgery as the treatment for high-grade VUR. Given the heterogeneity of VUR, underlying factors such as elevated detrusor pressure, increased urethral resistance, or persistently low ureteral resistance must be thoroughly evaluated and addressed prior to surgical intervention. As VUR remains one of the most debated conditions in pediatric urology, further studies are essential to improve risk stratification and refine treatment algorithms to optimize both infection control and renal preservation.