Treatment of vesico‐ureteric reflux: a new algorithm based on parental preference

Abstract

Authors from Rome evaluated parental preference for treatment in children with grade III VUR. Parents were provided with detailed information about the three treatment options: antibiotic treatment, open surgery, endoscopic treatment. Most parents chose endoscopic management; with this in mind, the authors proposed a new treatment algorithm for VUR. OBJECTIVE To assess parental preference (acknowledged in treatment guidelines as important when choosing therapy) about treatments for vesico‐ureteric reflux (VUR, commonly associated with urinary tract infection and which can cause long‐term renal damage if left untreated), as at present there is no definitive treatment for VUR of moderate severity (grade III). SUBJECTS AND METHODS The parents of 100 children with grade III reflux (38 boys and 62 girls, mean age 4 years, range 1–15) were provided with detailed information about the three treatment options available for treating VUR (antibiotic prophylaxis, open surgery and endoscopic treatment), including the mode of action, cure rate and possible complications, and the practical advantages and disadvantages. They were then presented with a questionnaire asking them to choose their preferred treatment. RESULTS Most parents preferred endoscopic treatment (80%), rather than antibiotic prophylaxis (5%) or open surgery (2%); 13% could not decide among the three options and endoscopic treatment was recommended. CONCLUSION Given the strong preference for endoscopic treatment we propose a new algorithm for treating VUR; endoscopic treatment would be considered as the first option for persistent VUR, except in severe cases where open surgery would still be recommended.

Endoscopic treatment of vesicoureteral reflux in children with subureteral dextranomer/hyaluronic acid injection: a single-centre, 7-year experience

“…4,33 Chertin and Kocherov 34 reviewed the current literature regarding the outcome of endoscopic treatment of VUR using different tissue-augmenting substances, with special emphasis on long-term efficacy. They found that the shortterm results in most series were similar to those reported for open surgery, but they also found a significant shortage of evidence-based literature on long-term follow-up after endoscopic correction of VUR using Deflux.…”

Endoscopic treatment of vesicoureteral reflux: current practice and the need for multifactorial assessment

“…Thus, only a small proportion of children with VUR would undergo open surgery. A very similar treatment strategy was advocated around the same time by other European authors [Capozza et al 2003]. These recommendations are compatible with parental preference: in a survey, 80% of parents expressed a preference for endoscopic treatment, compared with 5% for antibiotic prophylaxis and 2% for open surgery [Capozza et al 2003].…”

Discrepancy between power-Doppler voiding urosonography and voiding cystourethrography is not relevant for the management of primary vesicoureteric reflux

“…Although large international series have shown its effectiveness in the treatment of VUR [19,20], this treatment modality is not considered in the American Urological Association guidelines [1]. Hence, indications are still not generally agreed upon and its use is mostly based on single institution experience and local care policy [19,20] or on parents' preference [21]. Nevertheless, also for endoscopic treatment, grade of VUR does not seem to be a crucial factor any longer [19,20].…”