Survey results on medical and surgical followup of patients with vesicoureteral reflux from American Association of Pediatrics, Section on Urology members

Purpose: Little data are available on the appropriate followup protocols fo r patients treated medically or surgically for vesicoureteral reflux. We su rveyed urologists who primarily practice pediatric urology to determine cur rent practice patterns for following patients treated for vesicoureteral re flux. Materials and Methods: A 1-page survey was mailed to the 225 members of the American Academy of Pediatrics, Section on Urology. The mailing roster and labels were provided by the American Academy of Pediatrics. The survey inc luded questions on the followup of patients with low and high grade reflux treated medically or surgically. Returned surveys were blindly tabulated by 2 independent reviewers (F. A. F. and P. H. M.). Results: Of the 225 surveys 155 were returned and analyzed for an overall r esponse rate of approximately 61%. Urine culture is routinely performed by 64% and 71% of respondents to follow children with uncorrected low grade re flux and those with high grade reflux undergoing medical treatment, respect ively, generally at 3 to 6-month intervals. To follow patients with reflux voiding cystourethrography or radionuclide scan is performed yearly by 99% of study participants, while 77% perform ultrasound. Renal scan and excreto ry urography are done infrequently. The timing of the surgical correction o f unresolved asymptomatic reflux and/or when to discontinue antibiotics in these cases varied significantly among survey respondents. After antireflux surgery 92% and 91% of respondents perform voiding cystourethrography and ultrasound, respectively. Recommended followup after ureteroneocystotomy va ried greatly among survey participants. Conclusions: The overwhelming majority of practitioners agree on the timing and type of radiographic studies to be used to follow children treated for reflux and the majority routinely perform urine culture. Opinion on the co ntinuation of antibiotics and timing of surgical intervention for asymptoma tic unresolved reflux is divided. Wide variation exists on the recommended followup after reimplantation.