Vesicoureteral Reflux: Current Management in Children

López, Pedro-José; Celis, Sergio; Reed, Francisco; Zubieta, Ricardo

doi:10.1007/s11934-014-0447-9

Cited by 29 publications

(12 citation statements)

References 55 publications

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“…1, 2 These options include watchful waiting, antibiotic prophylaxis, endoscopic surgery, open surgery, and laparoscopic/robotic surgery. 3 Furthermore, the American Urological Association (AUA) VUR guidelines recommend a personalized approach to care that incorporates parental preferences into shared decision-making. 4 Shared decision-making has been shown to increase patient satisfaction and adherence to therapy, which is particularly applicable to VUR since treatment may require giving daily medications, close monitoring of symptoms, or sensitive post-operative care at home.…”

Section: Introduction and Objectivementioning

confidence: 99%

Parental Preference Assessment for Vesicoureteral Reflux Management in Children

et al. 2017

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Introduction & objective Parents of children with vesicoureteral reflux are presented with a variety of management options that in many cases offer a similar risk-benefit ratio. In order to facilitate shared decision-making, parental preferences regarding VUR treatment options need to be acknowledged. This study aims to characterize the clinical experience of parents and elicit core themes affecting decision-making in regards to managing their child’s vesicoureteral reflux. Methods A semi-structured, qualitative interview script was developed and vetted by 25 pediatric urologists to discuss treatment options for VUR. Additional patient interviews were conducted until new themes failed to arise. Content analysis was performed to extract all statements that described treatment options. Similar statements were combined until a final list of unique themes emerged. Results Twenty-six interviews were performed yielding 689 statements about parents’ overall experiences managing their child’s VUR, and 450 (65%) statements pertaining to treatment options. Thirteen themes emerged. Those most commonly considered by parents were: prevention future urinary tract infections (85%), efficacy rate of treatment options (85%), burden of daily maintenance or compliance (77%), antibiotic resistance (69%), chronic kidney damage (62%), and invasiveness (58%). Conclusions Our study emphasizes that when choosing a treatment option for their child’s VUR, parents’ preferences regarding risks and benefits are variable. However, their chief concerns include whether a method decreases the risk of UTIs, has an acceptable efficacy rate, and aligns itself with their family’s capabilities. These themes help frame discussions between families and clinicians regarding VUR management and can facilitate shared decision-making.

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Section: Introduction and Objectivementioning

confidence: 99%

Parental Preference Assessment for Vesicoureteral Reflux Management in Children

et al. 2017

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“…It is still one of the most common causes of renal failure in children [4]. VUR is classified as primary or secondary to a concomitant condition [5]. Primary vesicoureteral reflux is the result of anatomical defect of the vesicoureteric junction.…”

Section: Introductionmentioning

confidence: 99%

Clinical Course of Children and Adolescents with Primary Vesicoureteral Reflux: A retrospective study of 958 patients

et al. 2016

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Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant kidney scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children's Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new kidney scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6% of patients developed new kidney scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new scars may develop.

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“…VUR was still the main indication for ureteric reimplantation 9,10 . The best treatment approach for VUR is yet a highly debatable topic 11 . Despite the wider application of endoscopic injection therapy, some patients have residual reflux with repeated injections 1 .…”

Section: Introductionmentioning

confidence: 99%