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Comparison of interventions in pediatric primary vesicoureteral reflux: A network meta-analysis
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DOI：10.1016/j.jpedsurg.2025.162769.png)
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Abstract
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Purpose: For pediatric primary vesicoureteral reflux (VUR), there are several treatments but a ranking based on comparative efficacy and safety remains unclear. This network meta-analysis aims to rank the effectiveness and safety of multiple treatments for pediatric primary vesicoureteral reflux (VUR). The treatments evaluated include surgical reimplantation techniques (Lich-Gregoir, Politano-Leadbetter, Cohen), endoscopic treatments (Dx/HA, Macroplastiques, PPC), and antibiotic prophylaxis. Materials and methods: A comprehensive literature search was conducted according to PRISMA guidelines across electronic databases, including PubMed, Embase, and the Cochrane Library, from inception until the last update on October 31, 2024. The search only included randomized controlled trials (RCTs) focused on infants and children with VUR. The primary outcome was success rate, while the secondary outcomes were recurrence rate and complication rate. The data regarding efficacy and safety were extracted and analyzed using MetaInsight, and the indirect comparison values were calculated. A frequentist network meta-analysis with a random effects model was used to compare the survival outcomes across the different treatments. Results: Ten RCTs with 1179 patients were included. The success rate ranking from highest to lowest was: Lich-Gregoir, Politano-Leadbetter, Macroplastique, Cohen, PPC, Dx/HA, control, and antibiotics. No significant differences were observed among the treatments of adjacent ranking in the top six, but the top two (Lich-Gregoir and Politano-Leadbetter) had significantly better success rates than the control and antibiotic groups. Recurrence and complication rates showed no statistically significant differences among treatments, except for a higher complication rate in the Politano-Leadbetter group. These statistical results updated the previous assumption less recurrence happened in surgery. Conclusion: This is the first network meta-analysis of RCTs comparing multiple pediatric VUR treatments. Surgical and endoscopic interventions had similar success rates, while the Politano-Leadbetter technique was linked to more complications. These findings provide updated insights for clinical practice. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Keywords:
Vesicoureteral reflux
Network meta-analysis
Surgical reimplantation
Endoscopic treatment
Antibiotic prophylaxis
Pediatrics
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