Sterile reflux in the absence of obstruction does not cause renal damage (Belman, page 139; Ramsley and Risdon). The presence of recurrent urinary tract infections can have devastating and irreversible damage.
Factors affecting prognosis:
(1) host susceptibility to urinary tract infection (UTI)
(2) persistence of high grade reflux (Grade III or IV) after 3 years of age
(3) presence of Grade III or IV reflux
(4) large postvoid residual urine (associated with return of refluxed urine into the bladder)
(5) high intravesicular pressure associated with dysfunctional voiding (detrusor instability and/or voiding dyssynergy)
(6) prophylaxis to maintain urine sterility
Dysfunctional voiding may be associated with:
(1) urgency
(2) urgency dribbling
(3) incontinence
(4) worsening of vesicoureteral reflux
