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THE SWEDISH INFANT HIGH GRADE REFLUX TRIAL - VUR RESOLUTION
Josefin NORDENSTRÖM
1
, Gundela HOLMDAHL
2
, Per BRANDSTRÖM
1
, Eira STOKLAND
1
, Ulla SILLÉN
1
and Sofia
SJÖSTRÖM
1
1) The Queen Silvia Children's Hospital, The Pediatric Uro-Nephrologic Center, Gothenburg, SWEDEN - 2) The Queen
Silvia Children's Hospital, Department of Pediatric Surgery, Gothenburg, SWEDEN
PURPOSE
This study aimed to see if high grade vesicoureteral reflux (VUR) in infants can be treated with endoscopic injection and
if endoscopic treatment is superior to continuous antibiotic prophylaxis (CAP).
MATERIAL AND METHODS
In this randomized, controlled, multicenter, 1-year follow-up trial, 77 infants (55 boys, 22 girls) <8 months of age with
VUR grade 4-5(n=30/n=47) were included. 52(68%) had bilateral VUR. 39 were randomized to CAP and 38 to
endoscopic treatment (and prophylaxis till resolution). Voiding cystourethrogram (VCUG), ultrasound and renal
scintigraphy were performed at study entry and after one year for evaluation of VUR grade, dilatation and renal
function.
RESULTS
21(58%) in the endoscopy group and 8(21%) in the CAP group had VUR grade ≤2 at follow-up (p=0,0015). The success
rate in the endoscopy group was 100% in unilateral VUR grade 4, 75 % in bilateral VUR grade 4, 60 % in unilateral VUR
grade 5 and 31% in bilateral VUR grade 5 (p=0,004).
VUR resolution was also more frequent in VUR-grade 4 (40%) than VUR grade 5 (9%) and in unilateral VUR (33%) than
bilateral VUR (15%) in the CAP group.
One patient had an UTI possible related to injection therapy.
In our material 4 ureters required reimplantation, only one of them had vesicoureteral obstruction after injection.
CONCLUSIONS
High grade VUR in infants can be treated with injection therapy and resolution rate is higher compared to CAP
treatment. Complication rate is low and VUR grade 4 and unilaterality is favorable for resolution and down-grading of
high-grade infant VUR.