Abstract

MEVORACH, Robert A.; HULBERT, William C.; KLINE, Cheryl D.  and  RABINOWITZ, Ronald. Clinical care of vesicoureteral reflux: preventing adoption of a procedure-driven algorithm. Arch. Esp. Urol. [online]. 2008, vol.61, n.2, pp.127-134. ISSN 0004-0614.

Objectives: Although minimally invasive procedures have created a groundswell, supportive of early intervention as an expedient alternative to surveillance, we present a patient-driven model of care that weighs risk and benefit for each individual. Methods: A practice review was performed for the period 2000-2006. The records of all patients diagnosed by, or referred to, our group (three full-time Pediatric Urologists with a regional service population of 1.7 million) were included in an analysis of vesicoureteral incidence, initial management, and surgical approach. Results: During the review period, the incidence of newly diagnosed VUR increased at a rate of 4% per year, with 66% of these accrued from evaluation of pre-natal hydronephrosis and asymptomatic siblings of known reflux patients. The number of children with VUR and a significant component of DES also increased over time. During this period of higher case volume, surgical intervention failed to increase significantly, but did show a dramatic procedural shift toward minimally invasive techniques for all providers and probable delayed intervention in a substantive number of cases until endoscopic treatment was freely accessible between 2002-2004. Conclusion: Our patient-driven model respects current literature and clinical experience, while acknowledging that our understanding is still currently in evolution. As our knowledge grows, from well-designed prospective study, we adopt new techniques and retire archaic practices. At this point in time, however, we find evidence lacking to support adoption of a procedure-driven algorithm in the care of VUR.

Keywords : Reflux; Ureter; Surgery; Endoscopy; Vesicoureteral reflux.

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