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Abstract：
Vesicoureteral reflux (VUR) is one of the most common risk factors of urinary tract infection (UTI) among children. Various treatment modalities including antibiotic prophylaxis, surgical or endoscopic corrections and conservative treatment were used depending on the severity of VUR. The aim of this study is to compare the effectiveness of these treatment modalities in children with VUR grades II-IV by conducting a systematic review and network meta-analysis.
A systematic search from different databases was performed from their earliest records to December 2022 without any language restriction. Only randomised controlled trials were included in this study. Effectiveness of treatment modalities was mainly compared by UTI. Other outcomes for renal scarring and resolution by renal units were also measured between treatments.
A total of 11 studies with 1447 children were included in this study. While comparing with antibiotic prophylaxis in network meta-analysis for UTI recurrence, surgical treatment probably lowers the rate of UTI recurrence (Log OR -0.26, 95% CI -0.54 to 0.02, high quality). However, endoscopic treatment (Log OR 0.2, 95% CI -1.41 to 1.81, high quality) and conservative treatment (Log OR 0.15, 95% CI -0.45 to 0.75, high quality) revealed probably inferior to antibiotic treatment.
Both pairwise and network meta-analytic results probably showed no difference between the treatments in terms of their impact on UTI recurrence, progression of previous renal scars, or formation of new renal scars in children with VUR grades II-IV. These findings may offer a better understanding of each treatment and evidence-based suggestions for the choice of treatment, which should be individualised and based on the patient\'s risk factors.
A systematic search from different databases was performed from their earliest records to December 2022 without any language restriction. Only randomised controlled trials were included in this study. Effectiveness of treatment modalities was mainly compared by UTI. Other outcomes for renal scarring and resolution by renal units were also measured between treatments.
A total of 11 studies with 1447 children were included in this study. While comparing with antibiotic prophylaxis in network meta-analysis for UTI recurrence, surgical treatment probably lowers the rate of UTI recurrence (Log OR -0.26, 95% CI -0.54 to 0.02, high quality). However, endoscopic treatment (Log OR 0.2, 95% CI -1.41 to 1.81, high quality) and conservative treatment (Log OR 0.15, 95% CI -0.45 to 0.75, high quality) revealed probably inferior to antibiotic treatment.
Both pairwise and network meta-analytic results probably showed no difference between the treatments in terms of their impact on UTI recurrence, progression of previous renal scars, or formation of new renal scars in children with VUR grades II-IV. These findings may offer a better understanding of each treatment and evidence-based suggestions for the choice of treatment, which should be individualised and based on the patient\'s risk factors.
摘要：
背景：膀胱输尿管反流（VUR）是儿童尿路感染（UTI）最常见的危险因素之一。各种治疗方式，包括抗生素预防，根据VUR的严重程度,采用手术或内镜矫正和保守治疗.这项研究的目的是通过进行系统评价和网络荟萃分析，比较这些治疗方式在VURII-IV级儿童中的有效性。
方法：从最早的记录到2022年12月，对不同数据库进行了系统搜索，没有任何语言限制。本研究仅包括随机对照试验。主要通过UTI比较治疗方式的有效性。在治疗之间还测量了肾脏瘢痕形成和肾脏单位分辨率的其他结果。
结果：本研究共纳入11项研究，共1447名儿童。在UTI复发的网络荟萃分析中与抗生素预防相比，手术治疗可能降低UTI复发率(LogOR-0.26,95%CI-0.54~0.02,高质量).然而,内镜治疗(LogOR0.2,95%CI-1.41~1.81,高质量)和保守治疗(LogOR0.15,95%CI-0.45~0.75,高质量)可能不如抗生素治疗.
结论：配对和网络荟萃分析结果可能显示两种治疗方法对UTI复发的影响没有差异，先前肾疤痕的进展，或在VURII-IV级儿童中形成新的肾脏疤痕。这些发现可以更好地了解每种治疗方法，并为选择治疗提供基于证据的建议。这应该是个性化的，并根据患者的危险因素。
方法：从最早的记录到2022年12月，对不同数据库进行了系统搜索，没有任何语言限制。本研究仅包括随机对照试验。主要通过UTI比较治疗方式的有效性。在治疗之间还测量了肾脏瘢痕形成和肾脏单位分辨率的其他结果。
结果：本研究共纳入11项研究，共1447名儿童。在UTI复发的网络荟萃分析中与抗生素预防相比，手术治疗可能降低UTI复发率(LogOR-0.26,95%CI-0.54~0.02,高质量).然而,内镜治疗(LogOR0.2,95%CI-1.41~1.81,高质量)和保守治疗(LogOR0.15,95%CI-0.45~0.75,高质量)可能不如抗生素治疗.
结论：配对和网络荟萃分析结果可能显示两种治疗方法对UTI复发的影响没有差异，先前肾疤痕的进展，或在VURII-IV级儿童中形成新的肾脏疤痕。这些发现可以更好地了解每种治疗方法，并为选择治疗提供基于证据的建议。这应该是个性化的，并根据患者的危险因素。
