Interventions for primary vesicoureteric reflux

Williams, Gabrielle; Hodson, Elisabeth M; Craig, Jonathan C.

doi:10.1002/14651858.cd001532.pub5

Cited by 41 publications

(48 citation statements)

References 110 publications

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“…For this reason, NNT is subject to interpretation of the attending physician as to whether CAP might be considered moderately or even slightly beneficial. In addition, when deciding on management strategy, the rising concerns about uropathogen and multi-drug resistance to CAP needs to be balanced with the expected benefit of preventing new renal scarring [12,14,16,17,25,45,55]. In contrast, not only the prevention of renal scarring needs to be taken into account but also the often severe symptoms associated with fUTI, especially in small children [35].…”

Section: Discussionmentioning

confidence: 99%

Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis

et al. 2020

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Background Knowledge of the baseline risk of febrile urinary tract infections in patients with primary non-refluxing megaureter can help clinicians to make informed decisions for offering continuous antibiotic prophylaxis. Objective The primary objective of this systematic review was to determine the pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter selected for primary non-surgical management independent of associated attributed risk factors at initial presentation in order to assess the value of continuous antibiotic prophylaxis. Methods MEDLINE, EMBASE, and Cochrane Controlled Trials Register electronic databases were searched for eligible studies without language and time restriction. The systematic review was carried out following the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO registration number CRD42018104752). Results Of 25 871 records, 16 studies (n=749 patients) were eligible for inclusion. The overall pooled prevalence of febrile urinary tract infections in patients with primary non-refluxing megaureter was 14.35% (95% confidence interval: 8.8–22.6). The calculated number needed to treat for patients on continuous antibiotic prophylaxis to prevent one single febrile urinary tract infection over the course of 1–2 years would be 4.3. Conclusion Based on the current available evidence the use of continuous antibiotic prophylaxis for children with PM selected for primary non-surgical treatment should be taken into consideration, at least in patients with urinary outflow impairment, higher grade of ureteral dilatation, and for children in the first months of life.

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Section: Discussionmentioning

confidence: 99%

Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis

et al. 2020

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“…Despite the data showing possible benefits of antibiotic treatment, it is important to consider that VUR often persists for years, meaning that antibiotic prophylaxis is often needed for a prolonged duration. In contradiction to the studies above, a 2019 Cochrane review reported that long-term antibiotic prophylaxis “makes little or no difference to the risk of repeat UTI causing a person to be unwell” ( 34 ). Other studies also suggest that prophylactic antibiotic therapy can often be discontinued without incurring significantly increased UTI rates ( 75 ).…”

Section: Treatment Approachesmentioning

confidence: 96%

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

et al. 2021

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Vesicoureteral reflux (VUR) is associated with increased risks of urinary tract infection, renal scarring and reflux nephropathy. We review advancements over the last two decades in our understanding and management of VUR. Over time, the condition may resolve spontaneously but it can persist for many years and bladder/bowel dysfunction is often involved. Some factors that increase the likelihood of persistence (e.g., high grade) also increase the risk of renal scarring. Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for treatment. However, this procedure causes distress and radiation exposure. Therefore, strategies to reduce clinicians' reliance upon VCUG (e.g., after a VUR treatment procedure) have been developed. There are several options for managing patients with VUR. Observation is suitable only for patients at low risk of renal injury. Antibiotic prophylaxis can reduce the incidence of UTIs, but drawbacks such as antibiotic resistance and incomplete adherence mean that this option is not viable for long-term use. Long-term studies of endoscopic injection have helped us understand factors influencing use and the effectiveness of this procedure. Ureteral reimplantation is still performed commonly, and robot-assisted laparoscopic methods are gaining popularity. Over the last 20 years, there has been a shift toward more conservative management of VUR with an individualized, risk-based approach. For continued treatment improvement, better identification of children at risk of renal scarring, robust evidence regarding the available interventions, and an improved VUR grading system are needed.

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“…Also, the most recent Cochrane review on interventions for primary VUR (47) showed that antibiotic prophylaxis had insignificant difference to the risk of new/ continuous renal damage in patients followed with DMSA scans.…”

Section: Does Surgical Intervention Change the Future Of These Children?mentioning

confidence: 99%

Primary Vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt?

2020

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Interventions for primary vesicoureteric reflux

Abstract: Analysis 2.2. Comparison 2 Surgical reimplantation of ureters plus antibiotics versus antibiotics alone, Outcome 2 Renal parenchymal defects (scars and thinning) on IVP: unit of analysis (children).

Cited by 41 publications

References 110 publications

Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis

Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis

Management of Vesicoureteral Reflux: What Have We Learned Over the Last 20 Years?

Primary Vesicoureteral reflux and chronic kidney disease in pediatric population. What we have learnt?

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