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Interventions for primary vesicoureteric reflux.

E M Hodson1, D M Wheeler, D Vimalchandra

  • 1Children's Hospital at Westmead, Centre for Kidney Research, Locked Bag 4001, Westmead, NSW, Australia, 2145. Elisah@chw.edu.au

The Cochrane Database of Systematic Reviews
|July 20, 2007
PubMed
Summary
This summary is machine-generated.

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Treatment for childhood vesicoureteric reflux (VUR) offers minimal benefit. Surgery provides little advantage over antibiotics alone, with no significant reduction in urinary tract infections (UTIs) or renal damage.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Evidence-Based Medicine

Background:

  • Vesicoureteric reflux (VUR) is a condition where urine flows backward into the ureters.
  • Urinary tract infections (UTIs) in children with VUR can lead to permanent kidney damage.
  • Management strategies for VUR, including antibiotic prophylaxis and surgical correction, are debated.

Purpose of the Study:

  • To evaluate the benefits and harms of various treatment options for primary VUR in children.
  • To compare surgical correction, antibiotic prophylaxis, and combined therapies against each other and no treatment.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches (Cochrane, MEDLINE, EMBASE) up to June 2006.
  • Included any treatment for VUR: surgery, antibiotics, non-invasive techniques, or combinations.

Related Experiment Videos

  • Data were analyzed using random effects models, expressing dichotomous outcomes as relative risks (RR) with 95% confidence intervals (CI).

    • Main Results:

    • Eleven RCTs involving 1148 children were analyzed.
    • No significant difference in UTI risk at 2, 5, or 10 years between surgical and medical VUR management.
    • Combined treatment reduced febrile UTIs by 50% by 10 years but did not reduce renal damage.
    • Antibiotic prophylaxis showed no significant difference in UTI or renal damage risk compared to no treatment in two small studies.

    Conclusions:

    • The clinical benefit of treating children with VUR remains uncertain.
    • Surgical intervention for VUR offers minimal additional benefit compared to antibiotic therapy alone.
    • Nine reimplantations would be needed to prevent one febrile UTI, without decreasing overall UTI or renal damage incidence.