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An Immature Murine Model of Reversible Unilateral Ureteral Obstruction
Published on: April 4, 2025
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
Insights
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.
- 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.
Background:
Vesicoureteric reflux (VUR) results in urine passing, in a retrograde manner, up the ureter. Urinary tract infections (UTIs) have been considered the main cause of permanent renal parenchymal damage in children with reflux. Management of these children has been directed at preventing infection by antibiotic prophylaxis and/or surgical correction of reflux. Controversy remains as to the optimum strategies.
Objectives:
To evaluate the benefits and harms of different treatment options for primary VUR.
Search Strategy:
Randomised controlled trials (RCTs) were identified from the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of articles and abstracts from conference proceedings. Date of last search: June 2006
Selection Criteria:
Any treatment of VUR including surgery, antibiotic prophylaxis of any duration, non-invasive techniques and any combination of therapies.
Data Collection And Analysis:
Two authors independently searched the literature, determined study eligibility, assessed quality, extracted and entered data. For dichotomous outcomes, results were expressed as relative risk (RR) and 95% confidence intervals (CI). Data were pooled using the random effects model.
Main Results:
Eleven studies (1148 children) were identified. Seven compared correction of VUR (by surgery or endoscope) plus antibiotics for 1-24 months with antibiotics alone, two compared antibiotics with no treatment and two compared different materials for endoscopic correction of VUR. Risk of UTI by 2, 5 and 10 years was not significantly different between surgical and medical groups (2 years RR 1.07, 95% CI 0.32 to 2.09; 5 years RR 0.99, 95% CI 0.79 to 1.26; 10 years RR 1.06, 95% CI 0.78 to 1.44). Combined treatment resulted in a 50% reduction in febrile UTI by 10 years (RR 0.54, 95% CI 0.55 to 0.92) but no concomitant reduction in risk of new or progressive renal damage by 10 years (RR 1.03, 95% CI 0.53 to 2.00). In two small studies no significant differences in risk for UTI (RR 0.75, 95% CI 0.15 to 3.84) or renal damage (RR 1.70, 95% CI 0.36 to 8.07) were found between antibiotic prophylaxis and no treatment.
Authors' Conclusions:
It is uncertain whether the treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage.
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