The swedish refux trial in children. Ii. Outcome of vesicoureteral reflux

Abstract

Purpose To compare reflux status in children with dilating vesicoureteral reflux (VUR) managed in three groups: low-dose antibiotic prophylaxis, endoscopic treatment, and a surveillance group receiving antibiotic treatment only for febrile urinary tract infection. Material and Methods A total of 203 children with reflux grade III to IV and aged 1 to less than 2 years were recruited to this open, randomised, controlled trial. Endoscopic treatment was performed using dextranomer/hyaluronic acid copolymer (Dx/HA). Main endpoint was reflux status after 2 years. Results VUR status improved in all 3 treatment groups. Of the patients in the prophylaxis, endoscopic and surveillance groups, 39%, 71% and 47%, respectively, had resolution or downgrading of VUR to grades I and II after 2 years; this was significantly more frequent in the endoscopic than in the prophylaxis (p=0.0002) and surveillance group (p=0.0030). After one or two injections 86% of the patients in the endoscopic group had no or grade I to II reflux, but recurrence of reflux was seen in 20% of the patients after 2 years. Conclusions Endoscopic treatment with Dx/HA resulted in resolution or downgrading of dilating VUR in most of the treated children. After 2 years the results of the endoscopic treatment were significantly better than the spontaneous rate of resolution or downgrading in the prophylaxis and surveillance groups. Of concern is, however, the frequent reappearance of dilating VUR after 2 years seen in our study. To compare reflux status in children with dilating vesicoureteral reflux (VUR) managed in three groups: low-dose antibiotic prophylaxis, endoscopic treatment, and a surveillance group receiving antibiotic treatment only for febrile urinary tract infection. A total of 203 children with reflux grade III to IV and aged 1 to less than 2 years were recruited to this open, randomised, controlled trial. Endoscopic treatment was performed using dextranomer/hyaluronic acid copolymer (Dx/HA). Main endpoint was reflux status after 2 years. VUR status improved in all 3 treatment groups. Of the patients in the prophylaxis, endoscopic and surveillance groups, 39%, 71% and 47%, respectively, had resolution or downgrading of VUR to grades I and II after 2 years; this was significantly more frequent in the endoscopic than in the prophylaxis (p=0.0002) and surveillance group (p=0.0030). After one or two injections 86% of the patients in the endoscopic group had no or grade I to II reflux, but recurrence of reflux was seen in 20% of the patients after 2 years. Endoscopic treatment with Dx/HA resulted in resolution or downgrading of dilating VUR in most of the treated children. After 2 years the results of the endoscopic treatment were significantly better than the spontaneous rate of resolution or downgrading in the prophylaxis and surveillance groups. Of concern is, however, the frequent reappearance of dilating VUR after 2 years seen in our study.