What is the role of open surgery?

Open surgery (open repair) is an option for severe cases of VUR

Surgery can be used for high-grade unilateral or bilateral VUR

The open surgical repair of vesicoureteral reflux (VUR) is most commonly used in grades IV and V VUR.1 Endoscopic injection has assumed the role of first-line VUR treatment whereas reimplantation remains reserved for cases of failed injection therapy or significant anatomical abnormalities.2

What do children experience with open surgery?

  • Prolonged hospital stay3
  • Post-operative pain or discomfort3
  • Possible complications such as bleeding, blockages of the ureters, bladder issues1

Deflux has comparable protection to open repair

  • A single head-to-head study reviewing charts of children treated with either Deflux or surgery to compare the incidence of febrile and febrile UTI occurrence postoperatively showed:4
    • Deflux postoperative rate of UTI recurrence: 5% (N=40)
    • Open repair postoperative rate of UTI recurrence: 24% (N=29)

Considerations of Deflux versus open surgery

  • Comparable success rates with significant advantages: outpatient surgery, lower morbidity, fewer complications and reduced cost5
  • Deflux is the preferred and most often used treatment among providers in academic settings for long-term cure of reflux.6
  • VUR correction with Deflux is generally a 15-minute outpatient procedure requiring short-acting general anaesthesia versus a lengthier inpatient procedure requiring general anaesthesia2
  • The procedure is considered minimally invasive with minimal post-operative pain and no need for urinary catheter7
  • Children can usually return to school or normal activities the day after the procedure versus a surgical reimplant that generally requires hospitalisation for post-operative pain and temporary urinary catheter drainage.7

References:

  1. 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. DOI: 10.1046/j.1464-410x.2003.04325.x
  2. 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
  3. 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
  4. Elmore JM, Kirsch AJ, Heiss EA, et al. Incidence of urinary tract infections in children after successful ureteral reimplantation versus endoscopic dextranomer/hyaluronic acid implantation. J Urol. 2008;179:2364-2368. DOI: 10.1016/j.juro.2008.01.149
  5. 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(5):1846-1851. PMID: 9112544
  6. Osumah T, Gearman D, Ahmed M, et al. Preference and use of minimally-invasive techniques in vesicoureteral reflux: correlating a crowdsourced survey and American board of urology case logs. J Urol. 2019;201(4S):e945. DOI: 10.1016/j.eururo.2008.07.030
  7. Sung J, Skoog S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2012;27:551-561. DOI: 10.1007/s00467-011-1933-7
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