The evolving landscape of paediatric ureteric reimplantation-a contemporary outline of Australian practice

Abstract

Introduction: Open ureteric reimplantation has been the mainstay treatment modality for many years in Paediatric urology for the management of vesicoureteric reflux (VUR). Technical progress has produced reliable improvement in recurrence rates and durability nearing 95-100%. The true clinical risk of asymptomatic VUR however has been questioned in recent years with a selective evolution towards conservative management options. Objective: We aimed to o examine trends in the management of VUR with ureteric reimplantation in Australia over the last 20 years. Methods: Medicare Australia databases were accessed and Medicare rebate codes pertaining to ureteric reimplantation were extracted per state, year, age and gender between 1998 and 2019. Population data was extracted from the Australian Bureau of Statistics and represented the population at risk for calculation of incidence. Results: From 1998 to 2019, in the under 25 age group, 4923 ureteric reimplantation procedures were conducted in Australia. 4798 of these were under the age of 14 years old. There has been a 66.6% drop in the number of procedures between 1998 and 2019 for under 25 year old patients, from 5.98/1million to 1.63/1million. Majority of cases were conducted in the 0-4 age group (per capita). There was a trend of reduced numbers in each state - mostly seen in VIC with almost 93% reduction. Mean age of reimplantation did not significantly change over the 20 year time period from the data available. Conclusions: Over the past 20 years in Australia, there has been a significant reduction in the number of ureteric reimplantation procedures in the paediatric and adolescent population. This suggests a change in trend for the management of VUR towards less invasive treatment modalities.L6315819582020-04-30 <br />