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
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.
The parents of 100 children with grade III VUR were fully informed about three treatment options for VUR:1
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:
The 13% who were undecided were recommended endoscopic treatment.
In a survey that questioned 91 families of children with various grades of vesicoureteral reflux (VUR) about their treatment preferences:
A recent follow-up study showed high satisfaction with Deflux at a mean of 8.4 years post treatment:
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