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:

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
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
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
Sung J, Skoog S. Surgical management of vesicoureteral reflux in children. Pediatr Nephrol. 2012;27:551-561. DOI: 10.1007/s00467-011-1933-7
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
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