title: Clinical care of vesicoureteral reflux: preventing adoption of a procedure-driven algorithm.
abstract: OBJECTIVE
  Although minimally invasive procedures have created a groundswell, supportive of early intervention as on expedient alternative to surveillance, we present a patient-driven model of care that weighs risk and benefit for each individual.
  
  
  METHODS
  A practice review was performed for the period 2000-2006. The records of all patients diagnosed by, or referred to, our group (three full-time Pediatric Urologists with a regional service population of 1.7 million) were included in on analysis of vesicoureteral incidence, initial management, and surgical approach.
  
  
  RESULTS
  During the review period, the incidence of newly diagnosed VUR increased at a rate of 4% per year, with 66% of these accrued from evaluation of prenatal hydronephrosis and asymptomatic siblings of known reflux patients. The number of children with VUR and a significant component of DES also increased over time. During this period of higher case volume, surgical intervention failed to increase significantly but did show a dramatic procedural shift toward minimally invasive techniques for all providers and probable delayed intervention in a substantive number of cases until endoscopic treatment was freely accessible between 2002-2004.
  
  
  CONCLUSIONS
  Our patient-driven model respects current literature and clinical experience, while acknowledging that our understanding is still currently in evolution. As our knowledge grows, from well-designed prospective study, we adopt new techniques and retire archaic practices. At this point in time, however, we find evidence lacking to support adoption of a procedure-driven algorithm in the care of VUR.
authors.affiliation: Department of Urology, University of Rochester, Rochester, NY, USA. rober_mevorach@urmc.rochester.edu
authors.forename: Robert A
authors.initials: RA
authors.lastname: Mevorach
authors.forename: William C
authors.initials: WC
authors.lastname: Hulbert
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Kline
authors.forename: Ronald
authors.initials: R
authors.lastname: Rabinowitz
mesh_terms: D000465:Algorithms; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000628:therapy*