Parental experiences and preferences regarding the treatment of vesicoureteral reflux.
OBJECTIVE
Dilating vesicoureteral reflux (VUR) has been linked to febrile urinary tract infection (UTI) and renal scarring. It is unclear, however, whether children with reflux should be treated surgically or medically, or just kept under close surveillance with prompt treatment of UTIs. This lack of evidence makes parental preferences a crucial factor in the choice of therapy. The Swedish Reflux Trial was set up to compare the three treatment alternatives prospectively. This paper focuses on parental experience and satisfaction after completing the trial.


METHODS
A group of 203 children aged 12-24 months with reflux grade III or IV were randomly assigned to antibiotic prophylaxis (n = 69), surveillance (n = 68) or endoscopic injection treatment (n = 66) and followed closely for 2 years. Afterwards, the families were interviewed by an investigator not involved in the care of the children about their experience of the study.


RESULTS
Parental satisfaction with the treatment given was high, with 53% scoring 5 and 35% 4 on a five-grade scale, with no difference between the three groups (p = 0.5). Recurrence of febrile UTI or new kidney scarring did not influence parental satisfaction. Even though the satisfaction was high regardless of therapy, parents of children in the prophylaxis group more often than others would have chosen another treatment if given a choice.


CONCLUSIONS
As far as parental satisfaction and preferences are concerned, antibiotic prophylaxis, surveillance and injection treatment are equivalent treatment strategies in children with VUR.
Paediatric Nephrology Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. tryggve.neveus@kbh.uu.se
Tryggve
T
Nevéus
Per
P
Brandström
Tina
T
Linnér
Ulf
U
Jodal
Sverker
S
Hansson
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D010290:Parents; D057240:Patient Preference; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000628:therapy*; D057832:Watchful Waiting
D000900:Anti-Bacterial Agents; D003911:Dextrans; C094535:deflux; D006820:Hyaluronic Acid