SynthesisArchives of disease in childhood2003
Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials.
Synthesis in Archives of disease in childhood, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 49 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
49 citing papers in PubMed, 6 syntheses or guidelines pooled it, 199 citations in OpenAlex.
- Effectiveness of various treatment modalities in children with vesicoureteral reflux grades II-IV: a systematic review and network meta-analysis.BMJ paediatrics open · 2023Pooled it
- Interventions for primary vesicoureteric reflux.The Cochrane database of systematic reviews · 2019Pooled it
- To screen or not to screen for vesicoureteral reflux in children with ureteropelvic junction obstruction: a systematic review.European journal of pediatrics · 2017Pooled it
- Paediatric urinary tract infections: a retrospective application of the National Institute of Clinical Excellence guidelines to a large general practitioner referred historical cohort.Pediatric radiology · 2014Guideline
- Urinary tract infection in children.BMJ clinical evidence · 2010Pooled it
- A guideline for the inpatient care of children with pyelonephritis.Annals of Saudi medicineGuideline
- Antibiotic prophylaxis in the management of vesicoureteric reflux: a randomized double-blind placebo-controlled trial.Pediatric nephrology (Berlin, Germany) · 2015Trial
- Open vs. robot-assisted laparoscopic ureteral reimplantation in a contemporary pediatric cohort: a retrospective single-institution analysis.Journal of robotic surgery · 2026Article
- Pyeloplasty for the treatment of ectopic renal hydronephrosis in adults: a case series of six patients.Translational andrology and urology · 2024Article
- Recurrence of vesico-ureteral reflux in children: is still the endoscopic injection the best option?Translational andrology and urology · 2024Article
- Contemporary Management of Urinary Tract Infections in Children.Current treatment options in pediatrics · 2022Review
- Predicting long-term renal damage in children with vesicoureteral reflux under conservative initial management: 205 cases in a tertiary referral center.Central European journal of urology · 2018Article
- Controversies Regarding Management of Vesico-ureteric Reflux.Indian journal of pediatrics · 2017Review
- Parental Preference Assessment for Vesicoureteral Reflux Management in Children.The Journal of urology · 2017Article
- Urinary microprotein concentrations in the long-term follow-up of dilating vesicoureteral reflux patients who underwent medical or surgical treatment.International urology and nephrology · 2016Article
- Persistence and recurrence of vesicoureteric reflux in children after endoscopic therapy - implications of a risk-adapted follow-up.Central European journal of urology · 2015Article
- Relevance of current guidelines in the management of VUR.European journal of pediatrics · 2014Review
- Clinical value of persistent but downgraded vesicoureteral reflux after dextranomer/hyaluronic acid injection in children.Journal of Korean medical science · 2013Article
- The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection.Pediatric nephrology (Berlin, Germany) · 2012Review
- The demographics and costs of inpatient vesicoureteral reflux management in the USA.Pediatric nephrology (Berlin, Germany) · 2011Article
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsTo evaluate the benefits and harms of treatments for vesicoureteric reflux in children.
methodsMeta-analyses of randomised controlled trials using a random effects model. Main outcome measures were incidence of urinary tract infection (UTI), new or progressive renal damage, renal growth, hypertension, and glomerular filtration rate.
resultsEight trials involving 859 evaluable children comparing long term antibiotics with surgical correction of reflux (VUR) and antibiotics (seven trials) and antibiotics compared with no treatment (one trial) were identified. Risk of UTI by 1-2 and 5 years was not significantly different between surgical and medical groups (relative risk (RR) by 2 years 1.07; 95% confidence interval (CI) 0.55 to 2.09, RR by 5 years 0.99; 95% CI 0.79 to 1.26). Combined treatment resulted in a 60% reduction in febrile UTI by 5 years (RR 0.43; 95% CI 0.27 to 0.70) but no concomitant significant reduction in risk of new or progressive renal damage at 5 years (RR 1.05; 95% CI 0.85 to 1.29). In one small study no significant differences in risk for UTI or renal damage were found between antibiotic prophylaxis and no treatment.
conclusionIt is uncertain whether the identification and treatment of children with VUR confers clinically important benefit. The additional benefit of surgery over antibiotics alone is small at best. Assuming a UTI rate of 20% for children with VUR on antibiotics for five years, nine reimplantations would be required to prevent one febrile UTI, with no reduction in the number of children developing any UTI or renal damage.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.