How do the various treatment options compare?
VUR treatment options vary for grade and parental preference
Treatment options are based on a child’s age, grade of VUR, and other factors. The chart below details the advantages and disadvantages of these options, derived from a number of sources.1
Endoscopic injection with Deflux (NASHA/Dx gel) is associated with more advantages and fewer disadvantages than either antibiotic prophylaxis or ureteral reimplantation1
Informed discussions with parents1
The preference of the parents and/or the patient should be regarded as an essential consideration when choosing treatment. Parental preferences may be influenced by religion as well as personal bias. Informed discussion should take place between physician, parents and where applicable, the patient. Treatment options should be thoroughly explored, including the likely benefits, drawbacks, practical implications and clinical outcomes.
Antibiotic prophylaxis treatment
| Advantages | No surgical procedure1 Low risk of serious adverse events1 |
| Disadvantages | Continued need for VCUGs1 Breakthrough UTIs Risk of poor tolerability1 Risk of poor compliance1 Daily medicine required1 Resolution may not occur for many years, if at all1 Risk of antibiotic resistance1 |
| Reflux Resolution Rate | 16-49% Over 4-5 years, depending on reflux grade1 |
| UTI Recurrence 5-year frequency |
29-42%1 |
| Parental Preference Moderate VUR |
5%2 |
Deflux endoscopic treatment
| Advantages | Minimally invasive procedure1 Low risk of adverse effects1 Outpatient procedure (~15 min)1,3 Little chance of recurrent UTI after initial cure1 Little need for subsequent VCUG testing1 Open surgery/open repair still an option Low surgical complications4 Little pain4 Return to normal activity the next day4 |
| Disadvantages | Cure generally less certain than with open surgery1 More than one procedure may be required1 |
| Reflux Resolution Rate | 70-94%1,5 Depending on the injection technique, number of procedures performed and surgeon experience |
| UTI Recurrence 5-year frequency |
8%1 |
| Parental Preference Moderate VUR |
80%2 |
Surgical: ureteral reimplantation (open surgery/open repair)
| Advantages | Highly successful1 Little need for subsequent VCUG testing1 |
| Disadvantages | Major procedure1 Required hospital stay1 Postoperative pain likely1 Adverse events such as obstruction are possible1 Postoperative pain/recovery longer than expected in recent study5 Parents perceived overall more bleeding and spasms than anticipated5 High cost |
| Reflux Resolution Rate | 80-99% Depending on reflux grade and surgeon experience |
| UTI Recurrence 5-year frequency |
25-40%1 |
| Parental Preference Moderate VUR |
2%2 |
References
1. Kirsch AJ, Hensle T, Scherz H, Koyle M. Injection therapy: Advancing the treatment of vesicoureteral reflux. J Pediatr Urol. 2006;2(6):539-544. DOI: 10.1016/j.jpurol.2005.12.004
2. Capozza N, Lais A, Matarazzo E, Nappo S, Patricolo M, Caione P. Treatment of vesico-ureteric reflux: a new algorithm based on parental preference. BJU Int. 2003;92(3):285-288. DOI: 10.1046/j.1464-410x.2003.04325.x
3. Cerwinka WH, Scherz HC, Kirsch AJ. Endoscopic treatment of vesicoureteral reflux with dextranomer/hyaluronic acid in children. Adv Urol. 2008; 1-7. DOI: 10.1155/2008/513854
4. Sung J, Skoog S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2012;27:551-561. DOI: 10.1007/s00467-011-1933-7
5. Kirsch AJ, Arlen AM, Läckgren G. Current trends in dextranomer hyaluronic acid copolymer (Deflux) injection technique for endoscopic treatment of vesicoureteral reflux. J Pediatr Urol. 2014;84:462-468. DOI: 10.1016/j.urology.2014.04.032
6. Bayne A, Herbst K, Corbett S, Nelson E. Parental perception of bladder spasms and hematuria after surgery for reflux: a prospective multicenter study. J Urol. 2019;201(4S):e949. MP64-18
