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 MCUGs1
Breakthrough UTIs1
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 years1
Depending on reflux grade
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 MCUG 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 MCUG 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%1
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. 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
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