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

Area of Science:

• Pediatric Urology
• Nephrology

Background:

• Dilating vesicoureteral reflux (VUR) is a significant risk factor for urinary tract infections and renal scarring in children.
• Current management strategies include antibiotic prophylaxis, endoscopic injection, and surgical repair.

Purpose of the Study:

• To compare the efficacy of low-dose antibiotic prophylaxis, endoscopic therapy (dextranomer/hyaluronic acid copolymer), and surveillance for treating dilating VUR in children.
• To evaluate reflux status and resolution rates after a 2-year follow-up period.

Main Methods:

• An open-label, randomized controlled trial involving 203 children aged 1 to <2 years with grade III-IV VUR.
• Patients were randomized into three groups: antibiotic prophylaxis, endoscopic treatment, or surveillance (antibiotics for febrile UTIs only).
• The primary endpoint was reflux status at 2 years, analyzed on an intent-to-treat basis.

Main Results:

• All treatment arms showed improvement in reflux status.
• Endoscopic therapy achieved reflux resolution or downgrading to grade I-II in 71% of patients, significantly higher than prophylaxis (39%) and surveillance (47%) groups (p < 0.003).
• After 1-2 endoscopic injections, 86% had no or grade I-II reflux, but 20% experienced recurrent dilating reflux within 2 years.

Conclusions:

• Endoscopic treatment with dextranomer/hyaluronic acid copolymer is effective in resolving or downgrading dilating VUR in most children.
• Endoscopic therapy demonstrated superior outcomes compared to spontaneous resolution or downgrading seen with prophylaxis and surveillance at 2 years.
• The significant rate of recurrent dilating reflux after 2 years highlights the need for ongoing monitoring and potential re-intervention.