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Updated: Jan 13, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Comparison of interventions in pediatric primary vesicoureteral reflux: A network meta-analysis
Hsiao-Chien Ku1, Fu-Huan Huang2
1Division of Pediatric Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.
Insights
Surgical reimplantation and endoscopic treatments for pediatric vesicoureteral reflux (VUR) show similar success rates. Lich-Gregoir and Politano-Leadbetter surgeries offer the highest success, though Politano-Leadbetter has more complications.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Innovation
Background:
- Pediatric primary vesicoureteral reflux (VUR) management lacks clear comparative efficacy and safety data for available treatments.
- Existing treatments include surgical reimplantation (Lich-Gregoir, Politano-Leadbetter, Cohen), endoscopic procedures (Dx/HA, Macroplastiques, PPC), and antibiotic prophylaxis.
Purpose of the Study:
- To rank the comparative effectiveness and safety of multiple treatments for pediatric primary VUR using a network meta-analysis.
- To provide updated clinical insights for managing pediatric VUR.
Main Methods:
- A comprehensive literature search of randomized controlled trials (RCTs) in PubMed, Embase, and Cochrane Library up to October 31, 2024.
- Included studies focused on infants and children with VUR.
- Network meta-analysis using a frequentist random effects model to compare success, recurrence, and complication rates.
Main Results:
- Ten RCTs involving 1179 patients were analyzed.
- Lich-Gregoir and Politano-Leadbetter surgical techniques demonstrated significantly higher success rates than control and antibiotic groups.
- Surgical and endoscopic treatments showed similar success rates; Politano-Leadbetter was associated with a higher complication rate.
Conclusions:
- This network meta-analysis is the first to compare multiple pediatric VUR treatments based on RCTs.
- Surgical and endoscopic interventions exhibit comparable success rates.
- The Politano-Leadbetter technique, while effective, is linked to increased complications, informing clinical decision-making.
Purpose:
For pediatric primary vesicoureteral reflux (VUR), there are several treatments but a ranking based on comparative efficacy and safety remains unclear. This network meta-analysis aims to rank the effectiveness and safety of multiple treatments for pediatric primary vesicoureteral reflux (VUR). The treatments evaluated include surgical reimplantation techniques (Lich-Gregoir, Politano-Leadbetter, Cohen), endoscopic treatments (Dx/HA, Macroplastiques, PPC), and antibiotic prophylaxis.
Materials And Methods:
A comprehensive literature search was conducted according to PRISMA guidelines across electronic databases, including PubMed, Embase, and the Cochrane Library, from inception until the last update on October 31, 2024. The search only included randomized controlled trials (RCTs) focused on infants and children with VUR. The primary outcome was success rate, while the secondary outcomes were recurrence rate and complication rate. The data regarding efficacy and safety were extracted and analyzed using MetaInsight, and the indirect comparison values were calculated. A frequentist network meta-analysis with a random effects model was used to compare the survival outcomes across the different treatments.
Results:
Ten RCTs with 1179 patients were included. The success rate ranking from highest to lowest was: Lich-Gregoir, Politano-Leadbetter, Macroplastique, Cohen, PPC, Dx/HA, control, and antibiotics. No significant differences were observed among the treatments of adjacent ranking in the top six, but the top two (Lich-Gregoir and Politano-Leadbetter) had significantly better success rates than the control and antibiotic groups. Recurrence and complication rates showed no statistically significant differences among treatments, except for a higher complication rate in the Politano-Leadbetter group. These statistical results updated the previous assumption less recurrence happened in surgery.
Conclusion:
This is the first network meta-analysis of RCTs comparing multiple pediatric VUR treatments. Surgical and endoscopic interventions had similar success rates, while the Politano-Leadbetter technique was linked to more complications. These findings provide updated insights for clinical practice.
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