What do parents prefer?

Parents preferred endoscopic treatment to open surgery

“The personal preferences of parents (and, at older ages, patients) must be considered in weighing the benefits and harms of treatment options.”
American Urological Association Clinical Practice Guidelines1

In a survey that questioned 91 families of children with various grades of vesicoureteral reflux (VUR) about their treatment preferences;

  • 60% preferred endoscopy to open surgery despite potentially lower cure rates for endoscopic treatment versus open surgery.
  • Parents accepted the possibility of repeated treatments following endoscopic treatment.
  • An average of 60% of patients’ parents chose Deflux over treating with antibiotics for 3 to 5 years.2

In another study, the parents of 100 children with grade III VUR were fully informed about three treatment options for VUR:

  • antibiotic prophylaxis
  • endoscopic treatment
  • open surgery.3

It was explained that antibiotic prophylaxis is a preventative measure and does not cure VUR but avoids more invasive procedures. A cure rate of >95% was quoted for open surgery, compared with 70% for endoscopic treatment along with the advantage that complications are rare with endoscopic treatment. Based on the information presented, parents’ responses to a questionnaire showed:

  • 80% preferred endoscopic treatment
  • 5% opted for antibiotics
  • 2% preferred open surgery

Endoscopic treatment considered first line for moderately severe VUR3

80% of parents surveyed preferred endoscopic treatment rather than antibiotic prophylaxis or open surgery.

Taking into account the VUR treatment options preferred by parents of children with grade III VUR, investigators proposed a treatment algorithm with endoscopic treatment as first-line treatment for persistent VUR.

Open surgery is recommended for severe cases or those who have failed endoscopic treatment.3

Safety considerations for endoscopic treatment

Safety and efficacy of treatment of duplex systems, use of more than 6 mL of Deflux (3 mL at each ureteral orifice) at the same treatment session, and treatment of children under 1 year of age have not been established.

References:

  1. American Urological Association Pediatric Vesicoureteral Reflux Clinical Guidelines Panel. Report on the management of primary vesicoureteral reflux in children. Clinical Practice Guidelines. Linthicum, MD: American Urological Association, Inc; 1997.
  2. Ogan K, Pohl HG, Carlson D, Belman AB, Rushton HG. Parental preferences in the management of vesicoureteral reflux. J Urol. 2001;166(1):240-243.
  3. Capozza N, Lais A, Matarazzo E, Nappo S, Patricolo M, Caione P. Treatment of vesicoureteric reflux: a new algorithm based on parental preference. BJU Int. 2003;92(3):285-288