The Swedish reflux trial in children: II. Vesicoureteral reflux outcome.
OBJECTIVE
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.


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.
Holmdahl
Gundela
G
Pediatric Uro-Nephrologic Center, Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.
Brandström
Per
P
Läckgren
Göran
G
Sillén
Ulla
U
Stokland
Eira
E
Jodal
Ulf
U
Hansson
Sverker
S
D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D003911:Dextrans / Q000627:therapeutic use; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D007223:Infant; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D013548:Sweden; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
D003911:Dextrans; C487487:dextranomer-hyaluronic acid copolymer; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D006820:Hyaluronic Acid