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The Swedish Reflux Study - an introduction

Authors Per Brandström
Sverker Hansson
Published in European Society for Paediatric Nephrology, 42nd annual meeting, Lyon, Frankrike, 11-14 september 2008
Publication year 2008
Published at Institute of Clinical Sciences
Language en
Keywords Vesicoureteral reflux, treatment
Subject categories Pediatric surgery, Pediatrics


Objectives and study To evaluate three treatment options for vesicoureteral reflux (VUR) grade III-IV in children 1-2 years of age: cystoscopic Deflux injection, antibiotic prophylaxis, and observation with treatment of each UTI. Methods Open randomised multicentre study excluding children with major renal or urological malformations or neurogenic bladder dysfunction. Patients were randomised to the 3 treatment arms and followed for 24 months. Study endpoints are renal scarring at repeated DMSA scan and reflux status after 2 years, and rate of symptomatic urinary tract infections during follow-up. The influence of bladder dysfunction and the parents' experience of the management will also be studied. Follow-up will be completed by December 2008. Results 203 patients were included (75 boys and 128 girls). 51% of the boys and 69% of the girls had VUR grade III. Most children had a history of UTI before diagnosis of VUR. Non-E. Coli infections were more common in boys and in children with VUR grade IV. At randomisation the children were stratified according to sex, VUR grade, renal damage and centre. The 3 groups were comparable. At study entry there was no renal scarring in 52% of the children with VUR grade III, and in 25% of those with VUR grade IV. Conclusions The randomisation was successful in allocating the children to 3 comparable groups. The study will hopefully give answers to which treatment is best for young children with dilating VUR and may also give us valuable information on the impact of bladder dysfunction and about parental preferences.

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