Department of Pediatric Nephrology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Neurology, Children's Hospital of Shanxi (Women Health Center of Shanxi), Taiyuan, China.
Urol Int. 2021;105(11-12):1002-1010. doi: 10.1159/000518603. Epub 2021 Sep 23.
Vesicoureteral reflux (VUR) is a risk factor for various renal problems like recurrent urinary tract infections (UTIs), pyelonephritis, renal scarring, hypertension, and other renal parenchymal defects. The interventions followed by pediatricians include low-dose antibiotic treatment, surgical correction, and endoscopy. This meta-analysis aimed to assess the advantages and drawbacks of various primary VUR treatment options.
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of journals, and abstracts from conference proceedings were all used to find randomized controlled trials. The articles were retrieved from 1985 till 2020. Twenty articles were used for the data analysis. Criteria for Selection: Surgery, long-term antibiotic prophylaxis, noninvasive techniques, and any mix of therapies are also options for treating VUR. Collection and Interpretation of Data: Two authors searched the literature separately, determining research qualifications, assessing accuracy, and extracting and entering results. The odds ratio (OR) of these studies was used to construct the forest plot. The random-effects model was used to pool the data. Also, the random-effects model was used with statistical significance at a p value < 0.05 to assess the difference in side effects after treatment of VUR using different modalities.
We found no statistically significant differences between surgery plus antibiotics and antibiotic alone-treated patients in terms of recurrent UTIs (OR = 0.581; 95% confidence interval [CI] 0.259-1.30), renal parenchymal defects (OR = 1.149; 95% CI 0.75-1.754), and renal scarring (OR = 1.042; 95% CI 0.72-1.50). However, the risk of developing pyelonephritis after surgical treatment of VUR was lesser than that in the conservative approach, that is, antibiotics (OR = 0.345; 95% CI 0.126-0.946.), positive urine culture (OR = 0.617; 95% CI 0.428-0.890), and recurrent UTIs were more common in the placebo group than in the antibiotic group (p < 0.05; OR = 0.639; 95% CI 0.436-0.936) which is statistically significant.
Based on current research, we recommend that a child with a UTI and significant VUR be treated conservatively at first, with surgical care reserved for children who have issues with antimicrobials or have clinically significant VUR that persists after several years of follow-up.
输尿管反流（VUR）是各种肾脏问题的风险因素，如复发性尿路感染（UTI）、肾盂肾炎、肾瘢痕、高血压和其他肾实质缺陷。儿科医生的干预措施包括低剂量抗生素治疗、手术矫正和内窥镜检查。本荟萃分析旨在评估各种原发性 VUR 治疗选择的优缺点。
我们检索了 Cochrane 中央对照试验注册库、MEDLINE、EMBASE、期刊参考文献列表和会议论文集摘要，以寻找随机对照试验。这些文章的检索时间从 1985 年到 2020 年。我们使用了 20 篇文章进行数据分析。
手术、长期抗生素预防、非侵入性技术以及任何混合治疗方法也是治疗 VUR 的选择。
两位作者分别搜索文献，确定研究资格，评估准确性，并提取和输入结果。使用这些研究的优势比（OR）构建森林图。使用随机效应模型对数据进行合并。此外，使用随机效应模型，以 p 值 < 0.05 评估治疗 VUR 时使用不同方式的副作用差异。
我们发现手术加抗生素治疗与单独使用抗生素治疗患者在复发性 UTI（OR = 0.581；95%置信区间 [CI] 0.259-1.30）、肾实质缺陷（OR = 1.149；95% CI 0.75-1.754）和肾瘢痕（OR = 1.042；95% CI 0.72-1.50）方面无统计学显著差异。然而，与保守治疗（即抗生素）相比，手术治疗 VUR 后发生肾盂肾炎的风险较低（OR = 0.345；95% CI 0.126-0.946.），尿液培养阳性（OR = 0.617；95% CI 0.428-0.890）和复发性 UTI 更常见于安慰剂组而不是抗生素组（p < 0.05；OR = 0.639；95% CI 0.436-0.936），具有统计学意义。
根据目前的研究，我们建议首先对患有 UTI 和明显 VUR 的儿童进行保守治疗，对那些对微生物有问题或在数年随访后仍有持续存在的临床显著 VUR 的儿童保留手术治疗。
