Sun, 09/12/2010 - 10:38 | by admin
This section will review each of these treatment options in detail.
The long-term use of antibiotics is employed in treating VUR to prevent further urinary tract infection in children while waiting for the condition to resolve spontaneously with time.1, 2 The advantage of antibiotic prophylaxis is that it avoids the need for a surgical procedure.
However, antibiotic prophylaxis does require ongoing assessment of the VUR and perhaps repeated VCUGs to look for resolution of the condition. Depending on the age of the patient, the reflux grade and the number of previous infections, an initial short period of antibiotic prophylaxis is usually recommended.3, 4.
The potential of endoscopic injection as an alternative treatment option has been recognized for some years, as it avoids the need for long-term medication and the potential risks of open surgery.
However, existing guidelines on the treatment of VUR, including guidelines from the American Urological Association (AUA) published in 1997, did not include endoscopic injection as a standard treatment option due to a lack of suitable injectable materials.3
The ideal profile for an injectable material includes:
- Biocompatibility to allow good tissue tolerance
- Lack of migration from the injection site
- Ease of use
- High response rates
DEFLUX was approved for use and CE marked in Europe in 1998 for the treatment of all grades of VUR. Approval from the US Food and Drug Administration (FDA) was gained for DEFLUX in 2001 for the treatment of childhood VUR grades II–IV.
Open surgery for VUR involves reimplantation of the ureter where it joins the bladder to correct the anatomical abnormality that allows urine to reflux.5 Ureteral re-implantation is associated with high reported response rates (80–99%).4, 6, 7
However, it is a surgical procedure that carries with it associated risks of complications, including obstruction and new contralateral reflux.  Due to the invasive nature of the procedure, open surgery is usually reserved for children with high-grade reflux (grade V) or where previous treatments have failed.3, 4, 8
- Skoog SJ, Belman AB, Majd M. A nonsurgical approach to the management of primary vesicoureteral reflux. J Urol 1987; 138: 941-6.
- Kaneko K, Ohtomo Y, Shimizu T, et al. Antibiotic prophylaxis by low-dose cefaclor in children with vesicoureteral reflux. Pediatr Nephrol 2003; 18: 468-70.
- Elder JS, Peters CA, Arant BS, Jr., et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol 1997; 157: 1846-51.
- Läckgren G. Endoscopic treatment of vesicoureteral reflux and urinary incontinence in children. AUA Update Series 2003; Volume XXII, Lesson 37: 294-9.
- Ellsworth PI, Cendron M, McCullough MF. Surgical management of vesicoureteral reflux. AORN J 2000; 71: 498-513.
- Heidenreich A, Ozgur E, Becker T, et al. Surgical management of vesicoureteral reflux in pediatric patients. World J Urol 2004; 22:96-106.
- Duckett JW, Walker RD, Weiss R. Surgical results: International Reflux Study in Children—United States branch. J Urol 1992; 148:1674-5.
- Fanos V, Cataldi L. Antibiotics or surgery for vesicoureteric reflux in children. Lancet 2004; 364: 1720-2.