NE-AUA 2006 Annual Meeting, September 28 - 30, 2006, The Westin Hotel & Rhode Island Convention Center Providence, Rhode Island
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Factors Involved in Parental Decision-making for Surgical Correction of Vesicoureteral Reflux
Pamela Ellsworth, MD1, Katherine Callaghan2, Eileen Gray, NP3, Anthony Caldamone1.
1Brown University, Providence, RI, USA, 2University of Massachusetts Medical School, Worcester, MA, USA, 3University Urological Associates, Inc, Providence, RI,

Background: The surgical management of vesicoureteral reflux (VUR) has changed with the use of dextranomer microspheres. Dextranomer microspheres is an option for low to moderate grade VUR. We evaluated the possible factors which play a role in parental decision-making and to assess overall satisfaction with their choice.
Methods: A retrospective IRB approved review was performed including all patients who underwent surgery for VUR over the past 3 years. Parents completed a telephone-based survey. Parents were asked to rate on a scale of 1 (highest) to 6 (lowest) several factors which may affect decision-making, as well as their overall satisfaction with their choice.
Results: Seventy-nine parents consented to participate. Age of the child at the time of surgery ranged from 1.5 to 18 years. Indications for surgery included breakthrough UTIs in 31 children, persistent VUR < 4 years in 32 patients and persistent VUR > 4 years in 15 patients. Twenty-six patients underwent treatment with dextranomer microspheres, whereas 52 underwent ureteral reimplantation.

Factor

Open (52)

Open

Open

Open

Open

Open

Open

Rating

1

2

3

4

5

6

NR

Success rate

45

2

2

0

1

1

1

Long-term history

21

9

11

1

2

7

1

Invasiveness

5

11

11

6

3

15

1

Postop VCUG

11

4

3

3

9

21

1

 

 

 

 

 

 

 

 

Factor

Deflux (26)

Deflux

Deflux

Deflux

Deflux

Deflux

Deflux

Rating

1

2

3

4

5

6

NR

Success rate

4

9

6

1

1

2

3

Long-term history

4

5

5

1

1

6

4

Invasiveness

20

1

2

0

0

2

1

Postop VCUG

2

4

2

0

3

13

1


Fifty of the 52 parents of children undergoing ureteral reimplantation said yes they would choose the same procedure. The parents who said no had older children (15 and 18 years)at the time of surgery. Three parents of children in the dextranomer microspheres group said no. All of these children failed the first treatment attempt and 1 child failed a second attempt.
Conclusion: Aside from the recommendations of the family and physician, parents selecting open surgical correction consider the high success rate of the procedure and to a lesser degree, the lack of need for a postoperative VCUG. Overall, despite the increased morbidity of the procedure, parents are satisfied with their choice. Parents choosing dextranomer microspheres consider the minimally invasive nature of the procedure and itís relatively high success rate. The surgical outcome may affect satisfaction rate with dextranomer microspheres.


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