📃 Paper Title: Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children
🧍 Author: Ulf Jodal
🕒 Year: 2006
📚 Journal: Pediatric Nephrology
🌎 Country: Sweden
ㅤContext to the study:
Can you tell me about a trial comparing the outcomes of surgical and medical management of children with severe vesicoureteral reflux?
ㅤ✅ Take-home message of study:
This trial compared outcomes of children with severe VUR managed medically (antibiotics) and surgically (ureteric reimplantation).
Renal growth and UTI recurrence rates were similar, however medically treated patients had more febrile infections.
There was no difference in somatic growth, radionuclide imaging or renal function.
ㅤ Randomized controlled trial
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Study participants:
Number included: 306 children
Inclusion criteria: Under 11 years old, non-obstructive grade III or IV reflux, previous urinary tract infection (UTI), with or without renal scarring.
Exclusion criteria: outflow obstruction, other renal malformation, overt bladder dysfunction or previous urinary tract surgery
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Key study outcomes:
Primary outcomes: new renal scars and renal growth
Ureteral reimplantation was performed according to the individual surgeon's choice.
The medically treated group received continuous low-dose antibacterial prophylaxis with co-trimoxazole, trimethoprim or nitrofurantoin until the VUR had resolved or improved to grade I.
The 10-year results showed no overall statistical difference in outcome between the medical and surgical treatment groups in acquisition of urographic new scars, changes in images or differential function on DMSA studies, renal growth or function, or rate of recurrence of UTI.
However, a higher proportion of children in the medical group (21%) had febrile UTI than in the surgical group (11%) (P<0.01).
Study conclusions: with close supervision and prompt treatment of recurrences, children entering the study with GFR ≥70 ml/min per 1.73 m2 progressed remarkably well under either medical or surgical management, emphasizing the importance of continued supervision and the entry level of renal function.
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Study Limitations:
Not possible to distinguish between congenital dysplastic or hypoplastic kidneys and those with acquired scars.
Based on DMSA scintigraphy alone, it can be difficult to determine if an uptake defect represents acute inflammatory changes or permanent scarring.
Difficult to extend the follow-up period in a multi-centred, multi-national study.
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