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

Objective. We evaluated the efficacy of medical and surgical treatment of vesicoureteral reflux (VUR) in children by means of a meta-analysis, using the recurrence of urinary tract infections (UTIs), renal growth and renal scarring as end-points. Material and methods. We performed a MEDLINE search for articles published in the English language between 1966 and 2002. Of 639 relevant articles found, 139 were chosen for a close review and the main database was supplemented with some additional articles derived from the references of these reviewed articles. Five studies were found acceptable for a meta-analysis. We reviewed all articles independently. All reviewers had to approve the accepted articles and data that were used in this meta-analysis. Results. Operative treatment of VUR was better than medical treatment in terms of abolishing reflux ( OR = 0.033; 95% CI 0.010-0.107). We found no statistically significant differences between surgically and medically treated patients in terms of kidney growth ( OR = 2.46; 95% CI 0.74-8.16), scarring ( OR = 1.05; 95% CI 0.71-1.55) or recurrence of UTIs ( OR = 0.80; 95% CI 0.49-1.29). We could not evaluate possible differences in the parameters monitored between boys and girls because of a lack of data. Conclusions. Although surgical treatment of VUR is a common pediatric urologic procedure, the data relating to it are scanty. We found no clinically significant differences between surgical and medical treatment for VUR other than in the resolution of VUR itself. On the basis of present evidence we suggest that a child with UTI and significant VUR should be treated conservatively at first and that surgical treatment should be reserved for children who experience problems with antimicrobials or persistent clinically significant VUR after several years of follow-up.