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Published on: January 7, 2019
Parental experiences and preferences regarding the treatment of vesicoureteral reflux
Tryggve Nevéus1, Per Brandström, Tina Linnér
1Paediatric Nephrology Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. tryggve.neveus@kbh.uu.se
Insights
Parental satisfaction with treatments for vesicoureteral reflux (VUR) was high across antibiotic prophylaxis, surveillance, and endoscopic injection. These approaches are equivalent regarding parental experience and preferences in managing pediatric VUR.
Area of Science:
- Pediatric Urology
- Clinical Trial Research
- Patient-Reported Outcomes
Background:
- Dilating vesicoureteral reflux (VUR) is associated with febrile urinary tract infections (UTIs) and renal scarring.
- Optimal management strategies for pediatric VUR remain debated, with surgical, medical, and surveillance options.
- Parental preferences are a significant consideration in treatment decisions due to the lack of definitive evidence.
Purpose of the Study:
- To compare parental experience and satisfaction with three VUR treatment alternatives: antibiotic prophylaxis, surveillance, and endoscopic injection.
- To evaluate how treatment outcomes, such as recurrent febrile UTIs or new kidney scarring, impact parental satisfaction.
- To assess parental preferences for future treatment choices after participating in the Swedish Reflux Trial.
Main Methods:
- A prospective randomized trial involving 203 children aged 12-24 months with grade III or IV VUR.
- Children were assigned to antibiotic prophylaxis (n=69), surveillance (n=68), or endoscopic injection (n=66) and followed for 2 years.
- Post-trial interviews were conducted with families to gather data on their experiences and satisfaction.
Main Results:
- Overall parental satisfaction with the assigned treatment was high, with 88% scoring 4 or 5 on a 5-point scale.
- No significant differences in parental satisfaction were observed among the three treatment groups (p=0.5).
- Recurrence of febrile UTI or development of kidney scarring did not negatively affect parental satisfaction; however, parents in the prophylaxis group were more likely to prefer a different treatment if given another chance.
Conclusions:
- Antibiotic prophylaxis, surveillance, and endoscopic injection are equivalent treatment strategies for children with VUR when considering parental satisfaction and preferences.
- The study highlights the importance of incorporating parental perspectives into the management of pediatric VUR.
- High satisfaction levels across all groups suggest that effective communication and support can lead to positive patient experiences regardless of the chosen VUR intervention.
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.
Material And 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.
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