Surgical and endoscopic management for vesicoureteric reflux in Australia between 2000 to 2017 – trends and regional variances

Abstract

Introduction: Treatment of vesicoureteric reflux (VUR) has evolved significantly over past decades. We aimed to assess the current state of operative VUR management in Australia over the last 17 years using population-based data. Methods: Medicare Australia databases were accessed and rebate codes pertaining to ureteric reimplantation and cystoscopic bladder injections for VUR were extracted in relation to state and year between January 2000 and December 2017. Only data pertaining to patients 0-14 years of age was included. Procedure incidences were population-adjusted per 100,000 children using Australian Bureau of Statistics (ABS) data. Univariate linear regressions were used to evaluate changes in incidence. The 2012 to 2017 period was subanalysed to identify contemporary differences between states. Results: Between January 2000 to December 2017, Medicare Australia recorded 4543 procedures including 4027 ureteric reimplantations (88.6%) and 516 cystoscopic bladder injections (11.4%). Nationwide, there has been a 55% decrease in all operations for VUR (R = 0.83, p <0.0001). Ureteric reimplantation has decreased 4.1% per year from a peak of 9.7 to 3.1 per 100,000 (R 0.89, p < 0.0001). As a proportion of all procedures for VUR, cystoscopic bladder injections are increasingly common, representing 35.7% of all procedures in 2017 compared to 3.7% in 2000 (R = 0.93, p < 0.0001). Differences were identified between states. Between January 2012 to December 2017, median incidence of any procedural intervention for VUR varied between 1.6 to 12.2 per 100,000. Further, cystoscopic bladder injections as a proportion of all procedures ranged between 5% to 56%. Patient outcomes were however outside the scope of this study. Conclusions: Our findings suggest an overall trend in Australia towards non-operative and endoscopic management of VUR. Reasons for state-based differences requires further investigation.L20078919902021-03-04 <br />