What do parents prefer?
The American Urological Association Clinical Practice Guidelines suggests that the personal preferences of parents (and, at older ages, patients) must be considered in weighing the benefits and harms of treatment options.3
Informed discussions with parents4
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.
Parents preferred treatment
The parents of 100 children with grade III VUR were fully informed about three treatment options for VUR:1
- Antibiotic prophylaxis
- Endoscopic treatment
- Open surgery
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% preferred antibiotics
- 2% preferred open surgery
The 13% who were undecided were recommended endoscopic treatment.
Parents preferred endoscopic treatment to open surgery5
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.
High satisfaction rate among parents, 8.4 years post-op2
A recent follow-up study showed high satisfaction with Deflux at a mean of 8.4 years post treatment:
- 94.1% highly satisfied
- 2.4% partially satisfied
- 3.5% dissatisfied
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.2
References:
- 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
- Lightfoot M, Bilgutay AN, Tollin N, et al. Long-term clinical outcomes and parental satisfaction after dextranomer/hyaluronic acid (Dx/HA) injection for primary vesicoureteral reflux. Front Pediatr. 2019;7:392. DOI: 10.3389/fped.2019.00392
- 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.
- 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
- 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. PMID: 11435878
