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Meta-analysis of vesicoureteral reflux and urinary tract infection in children

Mika Venhola1, Niilo-Pekka Huttunen, Matti Uhari

  • 1Department of Pediatrics, Oulu University Hospital, Oulu, Finland. mika.venhola@ppshp.fi

Scandinavian Journal of Urology and Nephrology
|April 13, 2006
PubMed

Insights

Surgical treatment effectively resolves vesicoureteral reflux (VUR) in children. However, medical and surgical approaches show no significant differences in preventing recurrent urinary tract infections (UTIs), promoting kidney growth, or reducing renal scarring.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Evidence-Based Medicine

Background:

  • Vesicoureteral reflux (VUR) is a common condition in children, often associated with urinary tract infections (UTIs).
  • Treatment options include medical management and surgical correction, with ongoing debate regarding their comparative efficacy.
  • Assessing long-term outcomes like renal growth and scarring is crucial for guiding treatment decisions.

Purpose of the Study:

  • To conduct a meta-analysis evaluating the efficacy of medical versus surgical treatment for VUR in children.
  • To compare outcomes including the recurrence of UTIs, renal growth, and renal scarring between treatment groups.

Main Methods:

  • A comprehensive MEDLINE search was performed for English-language articles published between 1966 and 2002.
  • 139 articles were selected for detailed review, supplemented by additional sources from reference lists.
  • Five studies met the criteria for inclusion in the meta-analysis, with independent reviewer verification.

Main Results:

  • Surgical treatment demonstrated superior efficacy in abolishing VUR compared to medical management (OR = 0.033).
  • No statistically significant differences were observed between surgical and medical treatments regarding UTI recurrence (OR = 0.80), kidney growth (OR = 2.46), or renal scarring (OR = 1.05).
  • Data limitations precluded evaluation of treatment differences between boys and girls.

Conclusions:

  • While surgery effectively resolves VUR, clinical outcomes beyond reflux resolution do not significantly differ between medical and surgical treatments.
  • Conservative management is recommended as the initial approach for children with UTIs and significant VUR.
  • Surgical intervention should be reserved for cases with antimicrobial intolerance or persistent, clinically significant VUR after extended follow-up.
Abstract

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