title: The Swedish reflux trial: review of a randomized, controlled trial in children with dilating vesicoureteral reflux.
abstract: OBJECTIVE
  To evaluate prophylaxis and endoscopic injection for children with dilating vesicoureteral reflux (VUR) compared to surveillance, regarding urinary tract infection (UTI) recurrence, new renal damage, VUR outcome, and impact of lower urinary tract (LUT) dysfunction on these outcomes.
  
  
  METHODS
  203 children (128 girls and 75 boys), aged 1 to <2 years, with VUR grade III or IV were randomized to antibiotic prophylaxis (n = 69), endoscopic injection (n = 66) or surveillance (n = 68). Voiding cystourethrography, dimercaptosuccinic acid scintigraphy and optional LUT function assessment were performed before randomization and after 2 years.
  
  
  RESULTS
  There were 67 febrile UTIs in 42 girls and 8 in 7 boys (p = 0.0001). In girls, recurrence rate was 19% on prophylaxis, 23% with endoscopic treatment and 57% on surveillance (p = 0.0002). In boys, there was no difference between treatment groups. New damage was seen in 13 girls: 8 on surveillance, 5 in the endoscopic group and none on prophylaxis (p = 0.0155), and in 2 boys. In 13 children with no or non-dilating VUR after 1 injection, dilating VUR reappeared at the 2-year follow up. LUT dysfunction at follow up was associated with persistence of VUR.
  
  
  CONCLUSIONS
  In girls, prophylaxis reduced the rate of UTI recurrence and new renal damage, and endoscopic injection the rate of UTI recurrence. Boys did not benefit from active treatment.
authors.affiliation: Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, SE-416 85 Göteborg, Sweden. per.brandstrom@telia.com
authors.forename: Per
authors.initials: P
authors.lastname: Brandström
authors.forename: Ulf
authors.initials: U
authors.lastname: Jodal
authors.forename: Ulla
authors.initials: U
authors.lastname: Sillén
authors.forename: Sverker
authors.initials: S
authors.lastname: Hansson
mesh_terms: D019072:Antibiotic Prophylaxis; D003911:Dextrans / Q000008:administration & dosage*; D004108:Dilatation, Pathologic; D004724:Endoscopy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007223:Infant; D007267:Injections; D007668:Kidney / Q000473:pathology; D008297:Male; D019736:Prostheses and Implants; D012008:Recurrence; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy*; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control* / Q000628:therapy; D057832:Watchful Waiting
chemical_list: D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid