Faculty Bibliography

Vesicoureteral reflux is a well-recognized cause of childhood illness and renal damage. In the past, surgical reimplantation had been the only procedure available to gain the immediate cessation of reflux. The development of an endoscopic injection technique as a less morbid alternative to traditional surgery began in the 1980s. Teflon was the first injectable agent to be investigated. The record of Teflon is one of efficacy and apparent patient tolerance. However, concerns regarding possible migration and other side effects led to a search for other injectable agents. The most recently investigated agents are polydimethylsiloxane and dextranomer polymer. These agents do not have the long-term follow-up of Teflon, but appear to be effective and safe. Time will tell which agent will become the implant of choice, but it seems clear that endoscopic management will play an increasingly larger role in the care of vesicoureteral reflux.

The understanding of the complex branching morphogenesis of the early kidney is at an early stage; however, a framework is emerging that suggests numerous active genes sequentially switching on and reciprocally influencing each other. Much of our understanding of this process comes from studies of rodents specifically engineered to lack a particular gene responsible for an inductive agent or receptor. This review attempts to place newly discovered genetic programs within an organized framework of sequential renal development.