Parental perception of bladder spasms and hematuria after surgery for vesicoureteral reflux: A prospective multicenter study.

Introduction: Anti-reflux surgery success has been well-documented in the literature. Little data exists about the characterization of the child's symptoms regarding pain, bladder spasms, and hematuria following these procedures. These symptoms may affect the choice of surgery for families and providers.

Objective: To characterize parent's perception of recovery from surgery and preparedness for recovery from surgery. We hypothesized that parents of children undergoing open intravesical reimplantation (Open) would report a higher incidence of bladder spasms and hematuria compared to children undergoing robotic extravesical reimplantation (RALR) or endoscopic treatment (DxHA).

Study Design: A 20-question survey was developed to assess perception of recovery preparedness, pain, and symptoms. Parents completed the survey at a follow-up visit occurring 3-6 weeks post-discharge. Chi-square and t-test or their non-parametric equivalents were used for between-group comparisons.

Results: Participating were three institutions and eleven surgeons. Eighty-four parents completed the survey a median of 33 days (IQR 27-40) post-surgery. More parents reported bladder spasms and hematuria in the Open group vs RALR and DxHA. Although there was no difference in maximum bladder spasm pain, duration of pain medication for spasms was longer with Open vs RALR. Most parents (87%) reported they were prepared for their child's symptoms after surgery. Approximately one-quarter of parents whose child underwent Open (33%) or RALR (36%) reported the bladder spasms were more painful than expected, and almost half of parents whose child underwent Open (49%) reported hematuria was worse than expected.

Discussion: We found that Open had significantly worse parental reports of bladder spasms, pain medication usage, and severity of hematuria than RALR and DxHA. Although most parents said they were prepared for their child's recovery, many reported the symptoms were worse than expected. These contradictions may reflect a need for improved physician to parent communication when discussing anti-reflux surgery.