Parental preferences in the management of vesicoureteral reflux

Citation
K. Ogan et al., Parental preferences in the management of vesicoureteral reflux, J UROL, 166(1), 2001, pp. 240-243
Citations number
7
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
JOURNAL OF UROLOGY
ISSN journal
0022-5347 → ACNP
Volume
166
Issue
1
Year of publication
2001
Pages
240 - 243
Database
ISI
SICI code
0022-5347(200107)166:1<240:PPITMO>2.0.ZU;2-0
Abstract
Purpose: We determined parental preferences for the treatment of vesicouret eral, reflux in their child. Materials and Methods: Parents of children with vesicoureteral reflux were prospectively recruited to evaluate choices in reflux management. In each c ase a standard questionnaire that described the treatment options for reflu x was administered. Parents were asked to choose between long-term antibact erial prophylaxis with annual radiography studies and open or endoscopic tr eatment at each of 1 to 5 years of followup. They were also given the choic e between open or endoscopic treatment. Annual resolution and/or correction rates provided for medical, surgical and endoscopic management were 20%, 9 5% to 100% and 80% after 1 or 2 injections, respectively. Results: We queried 91 families of female (81%) and male (19%) patients. Av erage duration of; reflux followup was 2 years and mean patient age was 49. 8 months. At diagnosis reflux was grades I to II in 65% of cases, grade III in 26% and grades TV to V in 9%. The majority of parents chose daily antib iotics over surgery if the child was predicted to have vesicoureteral reflu x for I to 4 years. However, the majority chose ureteral reimplantation ove r daily antibiotics and yearly x-ray if a 5-year course was predicted. In c ontrast, parents chose daily antibiotics rather than endoscopic treatment i f the anticipated interval was 1 to 3 years. After 3 years the majority pre ferred the endoscopic approach. Also, 60% of parents stated that they would choose endoscopic treatment over reimplantation, although the child may re quire repeat endoscopic treatment and there was a 20% chance of persistent vesicoureteral reflux. Conclusions: Parents of children with vesicoureteral. reflux prefer antibio tic prophylaxis as initial treatment;. However, when daily antibiotics and yearly cystography may be required beyond 3 to 4 years, most parents would choose definitive correction. While endoscopic treatment is less effective than surgery, parents prefer endoscopic treatment, most likely because it i s less invasive. Also, when compared directly against each other, the major ity of parents stated that they would choose endoscopic treatment over surg ery, although it has a lower success rate.