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Open Ureteral Reimplantation Does Not Affect the Quality of Life in Children with Vesicoureteral Reflux: Assessment of Health-Related Quality-of-Life Using the Pediatric Quality of Life Inventory
David F. Yao, MD, Frank J. Penna, MD, Brian J. Minnillo, MD, Aaron C. Weinberg, BS, Hiep T. Nguyen,
Children's Hospital Boston, Boston, MA, USA.

BACKGROUND: Significant research has been dedicated to the diagnosis and management of vesicoureteral reflux (VUR). However, no study has been published to evaluate the impact of this disease on quality of life. Change in quality of life is an important, yet underreported means to assess the utility of surgery beyond traditional surgical and clinician assessed outcomes. The aims of this study were to prospectively assess the health-related quality of life (HRQoL) of children with VUR who have either been treated medically or with surgery using a validated patient satisfaction survey.
METHODS: A prospective, longitudinal study was conducted using a web-based validated survey, the Pediatric Quality of Life Inventory (PedsQL 4.0 Generic Core) to assess the HRQoL of four distinct domains: Physical (PF), Emotional (EF), Social (SF), and School Functioning (SCF). One hundred-six patients and 198 parents of patients age 2 to 18 with VUR completed the survey. We relied on parental proxy reporting for children less than 5 years. A historical cohort of 401 healthy patients and 717 healthy parental proxies served as controls. Of the 106 patients who participated, 53 (50%) underwent ureteral reimplantation (UR) and 53 (50%) were managed medically. Of the 198 parental proxy survey participants, 78 (39%) had children who had ureteral reimplantation and 118 (61%) had been managed medically. Two-tailed alpha was set at 0.05 for significance.
RESULTS: There was no difference in HRQoL between patients with VUR and healthy controls. Patients report equivocal HRQoL between ureteral reimplantation and medical management (84.66 to 85.09); however parents report lower scores with UR (85.59 to 89.10). Recent febrile UTI was associated with lower HRQoL (82.40 to 90.00). Both patients and parents described lower HRQoL with prophylactic antibiotic use, but results were not statisitically significant. Differences in grade of reflux, age, and ethnicity, were not associated with changes in HRQoL.
Table 1a: Patient Mean QoL Scores

VUR patientsHealthy Controlsp

VUR Patients vs.
Healthy Controls
SurgeryNo Surgeryp

Surgery
vs.
No Surgery
1064015353
Total84.8783.000.2384.6685.090.863
12.8314.7912.6913.08
PF92.1184.41<0.000191.4192.810.528
11.2817.2612.2310.34
EF78.3180.860.2378.8777.740.768
19.4719.6419.3619.75
SF88.1187.420.7188.8787.360.608
15.0317.1813.8216.25
SCF80.7678.630.3379.3982.140.427
17.7520.5316.6818.81
Table 1b: Parent-Proxy Mean QoL Scores
VUR patientsHealthy Controlsp

VUR Patients vs.
Healthy Controls
SurgeryNo Surgeryp

Surgery
vs.
No Surgery
19671778118
Total87.7087.610.9585.5989.100.035
11.4212.3312.8810.16
PF92.2589.320.0289.8293.870.028
12.6516.3515.0610.52
EF79.9382.640.0578.1881.080.244
16.9417.5417.8116.32
SF92.7691.560.2890.9593.960.083
11.9414.212.3511.56
SCF85.2685.470.8882.1887.380.027
15.4517.6116.5514.35

CONCLUSIONS: Vesicoureteral reflux, although a chronic condition, does not significantly impact HRQoL. From a patient HRQoL perspective, ureteral reimplantation and medical management were equivocal, but parental proxies interpret lower HRQoL with ureteral reimplantation.
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