Clinical care of vesicoureteral reflux: preventing adoption of a procedure-driven algorithm
Mevorach, R.A.; Hulbert, W.C.; Kline, C.D.; Rabinowitz, R.
Archivos Espanoles de Urologia 61(2): 127-134
2008
ISSN/ISBN: 0004-0614 PMID: 18491727 Document Number: 626945
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 7.7 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 of 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 locking to support adoption of a procedure-driven algorithm in the care of VUR.