Is availability of endoscopy changing initial management of vesicoureteral reflux?
PURPOSE: The optimal management of vesicoureteral reflux continues to be controversial. Since dextranomer/hyaluronic acid copolymer implants were approved in 2001 for endoscopic antireflux surgery, the perception that endoscopy is less morbid than open surgery, combined with concerns over potential adverse effects of prophylactic antibiotics, has led some to advocate endoscopy as initial therapy for reflux. We examined whether the availability of endoscopy has changed the management of reflux. MATERIALS AND METHODS: The i3 Innovus database (Ingenix, Eden Prairie, Minnesota) contains longitudinal claims data on more than 39 million patients spanning a 5-year period. We analyzed children diagnosed with vesicoureteral reflux (ICD-9 code 593.7, plus claim for radiographic or nuclear cystogram within 90 days) and at least 1 year of followup. We assessed patient characteristics, and diagnostic and therapeutic interventions. We evaluated surgical trends, including the changing use of endoscop
