Abstract
Purpose: We designed a multicenter, retrospective study to
investigate the current trends in initial management of reflux with
respect to EAU guidelines in Urology clinics of our country.
Materials and Methods: The study group consisted of 1988 renal
units (RU) of 1345 patients treated surgically due to VUR between years
2003-2017 in 9 different institutions. Patients were divided into 2
groups according to time of initial treatment and also grouped according
to risk factors by “EAU guidelines on VUR”.
Results: 1426 RUs were treated initially conservatively and 562
RUs were initially treated with surgery. In initially surgically treated
group, success rates of surgery decreased significantly in low and
moderate risk groups after 2013 (p=0.046, p=0.0001, respectively), while
success rates were not significantly different in high risk group
(p=0.46). While 26.6% of patients in low risk group were initially
surgically treated before 2013, this rate has increased to 34.6% after
2013, but the difference was not statistically significant (p=0.096).
However, performing surgery as the initial treatment approach increased
significantly in both moderate and high risk groups (p=0.000 and
p=0.0001, respectively) after 2013. Overall success rates of endoscopic
and UNC operations were 65% and 92.9% before 2013, 60% and 78.5%
after 2013, respectively. Thus the overall success rate for
surgery was 72.6%. There was significant difference between success
rates of UNC operations before and after 2013(p=0.000), while the
difference was not significant in the STING group (p=0.076).
Conclusion: Current trends in management of reflux in our
country do not yet follow the EAU guidelines on VUR in low and moderate
risk groups.
Keywords: Vesicoureteral reflux; reflux risk grouping; reflux
treatment management; EAU/ESPU guidelines on vesicoureteral reflux;
pediatric urology