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The Swedish Reflux Trial in Children: II. Vesicoureteral Reflux Outcome.

Journal article
Authors Gundela Holmdahl
Per Brandström
Göran Läckgren
Ulla Sillén
Eira Stokland
Ulf Jodal
Sverker Hansson
Published in The Journal of urology
Volume 184
Issue 1
Pages 280-285
ISSN 1527-3792
Publication year 2010
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 280-285
Language en
Links dx.doi.org/10.1016/j.juro.2010.01.0...
Subject categories Pediatrics, Pediatric surgery, Urology and andrology

Abstract

PURPOSE: We compared reflux status in children with dilating vesicoureteral reflux treated in 3 groups, including low dose antibiotic prophylaxis, endoscopic therapy and a surveillance group on antibiotic treatment only for febrile urinary tract infection. MATERIALS AND METHODS: A total of 203 children 1 to younger than 2 years with grade III-IV reflux were recruited into this open, randomized, controlled trial. Endoscopic treatment was done with dextranomer/hyaluronic acid copolymer. The main end point was reflux status after 2 years. Data were analyzed by the intent to treat principle. RESULTS: Reflux status improved in all 3 treatment arms. Of patients in the prophylaxis, endoscopic and surveillance groups 39%, 71% and 47%, respectively, had reflux resolution or downgrading to grade I-II after 2 years. This was significantly more common in the endoscopic than in the prophylaxis and surveillance groups (p = 0.0002 and 0.0030, respectively). After 1 or 2 injections 86% of patients in the endoscopic group had no or grade I-II reflux but recurrent dilating reflux was seen in 20% after 2 years. CONCLUSIONS: Endoscopic treatment resulted in dilating reflux resolution or downgrading in most treated children. After 2 years endoscopic treatment results were significantly better than the spontaneous resolution rate or downgrading in the prophylaxis and surveillance groups. However, of concern is the common reappearance of dilating reflux after 2 years.

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