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
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.