Cochrane · systematic review · CD001532
Interventions for primary vesicoureteric reflux
Williams, G, Hodson, EM, Craig, JC · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
Kidney and TransplantAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
33
current version
GRADE rated
29
No studies
4
Included studies
NR
No studies 4 · 12.1%Ungraded 0 · 0%Very low 5 · 15.2%Low 16 · 48.5%Moderate 8 · 24.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Antibiotic prophylaxis versus surveillance or no treatment for primary vesicoureteric reflux
Population: primary VUR
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Symptomatic UTI by 1 to 2 years: antibiotics versus no prophylaxis Antibiotic prophylaxis vs surveillance or no treatment | RR 0.77 [0.54, 1.09] | 9 studies · 1667 participants | Low |
Febrile UTI by 1 to 2 years: antibiotics versus no prophylaxis Antibiotic prophylaxis vs surveillance or no treatment | RR 0.83 [0.56, 1.21] | 9 studies · 1667 participants | Low |
Symptomatic UTI; antibiotics versus placebo in trials with low risk of bias across all domains Antibiotic prophylaxis vs surveillance or no treatment | RR 0.85 [0.4, 1.79] | 3 studies · 943 participants | Moderate Downgraded: imprecision, inconsistency |
Resolution of VUR after 1 to 2 years: unit of analysis (children) Antibiotic prophylaxis vs surveillance or no treatment | RR 1.46 [0.71, 2.99] | 3 studies · 262 participants | Low |
Adverse events Antibiotic prophylaxis vs surveillance or no treatment | RR 0.94 [0.81, 1.08] | 4 studies · 1056 participants | Moderate Downgraded: imprecision, inconsistency |
Microbial resistance to prophylactic drug: unit of analysis (UTI) Antibiotic prophylaxis vs surveillance or no treatment | RR 2.72 [1.85, 4] | 6 studies · 259 participants | Moderate Downgraded: imprecision, inconsistency |
Surgical reimplantation of ureters plus antibiotics versus antibiotics alone for primary vesicoureteric reflux
Population: primary VUR
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All symptomatic UTI by 4 to 5 years: surgical correction + antibiotics versus antibiotics alone Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 0.95 [0.67, 1.35] | 1 study · 297 participants | Moderate Downgraded: imprecision |
Febrile UTI by 5 years: surgical correction + antibiotics versus antibiotics alone Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 0.43 [0.27, 0.7] | 2 studies · 429 participants | Moderate Downgraded: risk of bias, imprecision |
Repeat positive urine cultures by 4 to 5 years: surgical correction + antibiotics versus antibiotics alone Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 0.99 [0.79, 1.26] | 3 studies · 479 participants | Moderate Downgraded: risk of bias, imprecision |
New renal parenchymal defects (scars and thinning) on IVP: unit of analysis (children) at 4 to 5 years: surgical correction + antibiotics versus antibiotics alone Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 1.09 [0.79, 1.49] | 4 studies · 572 participants | Moderate Downgraded: risk of bias, imprecision |
ESKD Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 1.07 [0.23, 5.04] | 2 studies · 154 participants | Very low Downgraded: risk of bias, imprecision |
Hypertension Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 0.93 [0.25, 3.42] | 2 studies · 154 participants | Very low Downgraded: risk of bias, imprecision |
Correction of VUR: unit of analysis (children) after 3 years: surgical correction + antibiotics versus antibiotics alone Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | RR 1.29 [0.55, 3.05] | 1 study · 55 participants | Very low Downgraded: risk of bias, imprecision |
Number of UTI with microbial resistance (resistant organisms) Surgical reimplantation of ureters plus antibiotics vs antibiotics alone | no estimate extracted | NR | No studies |
Endoscopic injection treatment versus antibiotics alone for primary vesicoureteric reflux
Population: primary VUR
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All symptomatic UTI by 1 to 2 years: endoscopic correction + antibiotics versus antibiotics alone Endoscopic injection treatment vs antibiotics alone | RR 0.8 [0.37, 1.75] | 3 studies · 254 participants | Low Downgraded: risk of bias |
Febrile UTI by 1 to 2 years: endoscopic correction + antibiotics versus antibiotics alone Endoscopic injection treatment vs antibiotics alone | RR 0.74 [0.31, 1.78] | 3 studies · 254 participants | Low Downgraded: risk of bias |
Repeat positive urine culture by 1 year Endoscopic injection treatment vs antibiotics alone | RR 7.15 [0.42, 121.04] | 1 study · 60 participants | Very low Downgraded: risk of bias |
Total new and progressive Renal parenchymal abnormalities on DMSA scan at 1 to 2 years: endoscopic correction + antibiotics versus antibiotics alone (unit of analysis: children) Endoscopic injection treatment vs antibiotics alone | RR 1.2 [0.36, 3.96] | 2 studies · 208 participants | Low Downgraded: risk of bias |
Resolution of VUR (grade 0) for endoscopic correction + antibiotics versus antibiotics alone (unit of analysis: children) Endoscopic injection treatment vs antibiotics alone | RR 2.69 [1.57, 4.63] | 2 studies · 164 participants | Low Downgraded: risk of bias |
Microbial resistance to the prophylactic drug Endoscopic injection treatment vs antibiotics alone | RR 0.63 [0.34, 1.15] | 1 study · 24 participants | Very low Downgraded: risk of bias |
Macroplastique versus dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux
Population: primary VUR
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Number of children with febrile UTI Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | RR 1.09 [0.45, 2.66] | 1 study · 255 participants | Low Downgraded: risk of bias, imprecision |
Number of children with afebrile UTI Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | RR 1.68 [0.52, 5.44] | 1 study · 72 participants | Low Downgraded: risk of bias, imprecision |
Number of ureters with persistent VUR > grade 1 at 1 year Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | RR 0.54 [0.35, 0.83] | 2 studies · 472 participants | Moderate Downgraded: risk of bias, imprecision |
Number of kidneys with temporary renal dilatation after injection Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | RR 1.85 [1.02, 3.35] | 1 study · 114 participants | Low Downgraded: risk of bias, imprecision |
Ureteral obstruction Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | RR 1.46 [0.25, 8.66] | 1 study · 399 participants | Low Downgraded: risk of bias, imprecision |
Post operative flank pain Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | RR 1.45 [0.33, 6.36] | 1 study · 255 participants | Low Downgraded: risk of bias, imprecision |
New renal parenchymal defects on DMSA scan (kidney injury) Macroplastique vs dextranomer/hyaluronic acid polymer (Deflux) to correct vesicoureteric reflux | no estimate extracted | NR | No studies |
Probiotics versus antibiotic prophylaxis for primary vesicoureteric reflux
Population: primary VUR
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All symptomatic UTI by 1 year Probiotics vs antibiotic prophylaxis | RR 0.82 [0.56, 1.21] | 2 studies · 248 participants | Low Downgraded: imprecision |
Febrile UTI by 1 year Probiotics vs antibiotic prophylaxis | RR 0.82 [0.37, 1.83] | 1 study · 120 participants | Low Downgraded: imprecision |
E. coli resistance to prophylactic drug Probiotics vs antibiotic prophylaxis | RR 0.38 [0.21, 0.69] | 2 studies · 38 participants | Low Downgraded: imprecision |
Renal parenchymal defects on DMSA scan ‐ Patient data at 1 year Probiotics vs antibiotic prophylaxis | RR 0.69 [0.43, 1.11] | 2 studies · 152 participants | Low Downgraded: imprecision |
Resolution of VUR Probiotics vs antibiotic prophylaxis | no estimate extracted | NR | No studies |
Adverse events Probiotics vs antibiotic prophylaxis | no estimate extracted | NR | No studies |