anticholinergics. Surgical management A surgical approach is necessary in cases where a breakthrough infection results despite prophylaxis, or there is non-compliance with the prophylaxis. Similarly if the VUR is severe (Grade IV & V), there are pyelonephritic changes or congenital abnormalities. Other reasons necessitating surgical intervention are failure of renal growth, formation of new scars, renal deterioration and VUR in girls approaching puberty. There are four types of surgical procedure available for the treatment of VUR: endoscopic (STING/HIT procedures); laparoscopic; robotic-assisted laparoscopic; and open procedures (Cohen procedure, Leadbetter-Politano procedure, Lich-Gregoir technique). Laparoscopic and robotic-assisted laparoscopic procedures are often imitation of classical open procedures in laparoscopic or robotic-assisted laparoscopic environments. Surveillance The American Urological Association recommends ongoing monitoring of children with VUR until the abnormality resolves or is no longer clinically significant. The recommendations are for annual evaluation of blood pressure, height, weight, analysis of the urine, and kidney ultrasound. Epidemiology It has been estimated that VUR is present in more than 10% of the population. Younger children are more prone to VUR because of the relative shortness of the submucosal ureters. This susceptibility decreases with age as the length of the ureters increases as the children grow. In children under the age of 1 year with a urinary tract infection, 70% will have VUR. This number decreases to 15% by the age of 12. Although VUR is more common in males antenatally, in later life there is a definite female preponderance with 85% of cases being female. History As early as the time of Graeco-Roman physician and anatomist Galen described the urinary tract and noted that there were specific mechanisms to prevent the reflux of urine. References External links Urinary bladder disorders