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Interventions for primary vesicoureteric reflux.

D M Wheeler1, D Vimalachandra, E M Hodson

  • 1Department of Clinical Epidemiology, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, Australia, 2145.

The Cochrane Database of Systematic Reviews
|July 22, 2004
PubMed
Summary
This summary is machine-generated.

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The optimal management strategy for primary vesicoureteric reflux (VUR) in children remains uncertain. While combined treatments may reduce febrile urinary tract infections (UTIs), they do not significantly lower the risk of renal damage.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Evidence-Based Medicine

Background:

  • Vesicoureteric reflux (VUR) is a condition where urine flows backward from the bladder to the ureters.
  • Urinary tract infections (UTIs) in children with VUR can lead to permanent kidney damage.
  • Current management strategies, including antibiotic prophylaxis and surgical correction, aim to prevent UTIs but lack definitive optimal approaches.

Purpose of the Study:

  • To evaluate the benefits and harms associated with various treatment options for primary VUR in children.
  • To synthesize evidence from randomized controlled trials (RCTs) to inform clinical decision-making.

Main Methods:

  • A systematic literature search was conducted across multiple databases (Cochrane Register, MEDLINE, EMBASE) and conference proceedings.

Related Experiment Videos

  • Included RCTs compared different VUR treatments: surgery (open/closed), antibiotic prophylaxis, non-invasive methods, and combination therapies.
  • Data were extracted, quality assessed, and dichotomous outcomes analyzed using relative risk (RR) and random effects models.

    • Main Results:

    • Ten RCTs involving 964 children were analyzed.
    • No significant difference in UTI risk was observed between surgical and medical management at 1-2 and 5 years.
    • Combined treatment reduced febrile UTIs by 60% at 5 years but did not significantly decrease renal damage risk. Antibiotic prophylaxis alone showed no significant benefit over no treatment.

    Conclusions:

    • The clinical benefit of identifying and treating children with VUR is uncertain.
    • The added benefit of surgery over antibiotics alone appears minimal.
    • Nine surgical reimplantations would be needed to prevent one febrile UTI in children with VUR on antibiotics for five years, without reducing overall UTI or renal damage.