What are the Effective Factors in Spontaneous Resolution Rate of Primary Vesicoureteral Reflux: A Meta-Analysis and Systematic Review
Urology Journal,
Vol. 20 No. 06 (2023),
26 December 2023
,
Page 385-396
https://doi.org/10.22037/uj.v20i06.8095
Abstract
Purpose: This meta-analysis aimed to predict the rate of spontaneous resolution and identify influencing factors
among pediatric patients with primary vesicoureteral reflux (VUR). The primary objective was to construct a nomogram to facilitate clinical decision-making in the treatment of primary VUR by assessing the rate of spontaneous resolution and its determinants.
Materials and Methods: A systematic search was conducted up to September 2023, encompassing databases such
as PubMed, Web of Science, Scopus, and the reference lists of relevant studies. Inclusion criteria comprised 33
studies with a total of 8540 pediatric patients. Data extraction was performed independently by two reviewers, with
discrepancies resolved by a third reviewer. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Form. The analysis included the assessment of various outcomes, such as the rate of spontaneous resolution, and identification of influential factors, including gender, age, laterality, and VUR grade.
Results: The pooled spontaneous resolution rate among pediatric patients with primary VUR was 0.42 (95% CI:
0.38 to 0.47, Tau2 = 0.26), demonstrating high heterogeneity (Q = 429.9, df = 32, P < 0.001, I2 = 93%). Egger's
regression test indicated no publication bias (p = 0.67). VUR grade emerged as the most significant determinant of
spontaneous resolution, with varying rates for different grades: grade 1 (0.80, 95% CI: 0.72-0.86), grade 2 (0.67,
95% CI: 0.60-0.74), grade 3 (0.49, 95% CI: 0.42-0.56), and grade 4 (0.23, 95% CI: 0.18-0.30; Tau2 = 0.28, I2 =
0.49). While differences in gender and laterality were observed, statistical significance was not evident.
Conclusion: This study provides valuable insights into the spontaneous resolution rate of primary vesicoureteral
reflux in pediatric patients. The constructed nomogram, based on VUR grading, serves as a useful tool for clinicians
in decision-making. Despite observed variations in gender and laterality, only VUR grading demonstrated
statistical significance in influencing spontaneous resolution. Further research is recommended to explore additional factors within larger populations to enhance our understanding of primary VUR resolution dynamics.
- primary vesicoureteral reflux; spontaneous resolution; pediatrics; vesicoureteral reflux grade; systematic review
How to Cite
References
Blais, A.S., S. Bolduc, and K. Moore, Vesicoureteral reflux: From prophylaxis to surgery. Can Urol Assoc J, 2017. 11(1-2Suppl1): p. S13-s18.
Bourchier, D., G.D. Abbott, and T.M. Maling, Radiological abnormalities in infants with urinary tract infections. Arch Dis Child, 1984. 59: p. 620-4.
Drachman, R., M. Valevici, and P.A. Vardy, Excretory urography and cystourethrography in the evaluation of children with urinary tract infection. Clin Pediatr (Phila), 1984. 23: p. 265-7.
Prasad, M.M. and E.Y. Cheng, Imaging studies and biomarkers to detect clinically meaningful vesicoureteral reflux. Investig Clin Urol, 2017. 58(Suppl 1): p. S23-s31.
Smith, J.M., et al., Contributions of the Transplant Registry: The 2006 Annual Report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Pediatr Transplant, 2007. 11: p. 366-73.
Chandra, M., H. Maddix, and M. McVicar, Transient urodynamic dysfunction of infancy: relationship to urinary tract infections and vesicoureteral reflux. J Urol, 1996. 155: p. 673-7.
Sillén, U., et al., Pronounced detrusor hypercontractility in infants with gross bilateral reflux. J Urol, 1992. 148(2 Pt 2): p. 598-9.
Thorup, J.M., Urodynamics in boys after prenatally diagnosed vesicoureteric reflux. Pediatr Surg Int, 1996. 11: p. 14-7.
Hains, D.S., et al., Elucidation of Renal Scars in Children With Vesicoureteral Reflux Using Contrast-Enhanced Ultrasound: A Pilot Study. Kidney Int Rep, 2017. 2: p. 420-424.
Elder, J.S., et al., Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol, 1997. 157: p. 1846-51.
Estrada, C.R., Jr., et al., Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol, 2009. 182: p. 1535-41.
ANDERSON, P.A.M. and A.M.K. RICKWOOD, Features of Primary Vesicoureteric Reflux Detected by Prenatal Sonography. British Journal of Urology, 1991. 67: p. 267-271.
Bouachrine, H., et al., A follow-up study of pre-natally detected primary vesico-ureteric reflux: a review of 61 patients. Br J Urol, 1996. 78: p. 936-9.
Burge, D.M., et al., Fetal vesicoureteral reflux: outcome following conservative postnatal management. J Urol, 1992. 148(5 Pt 2): p. 1743-5.
Steele, B.T. and J. De Maria, A new perspective on the natural history of vesicoureteric reflux. Pediatrics, 1992. 90(1 Pt 1): p. 30-2.
Yeung, C.K., et al., The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis. Br J Urol, 1997. 80: p. 319-27.
Shaikh, N., et al., Cost-Utility of Antimicrobial Prophylaxis for Treatment of Children With Vesicoureteral Reflux. Front Pediatr, 2019. 7: p. 530.
Khoshdel, A., J. Attia, and S.L. Carney, Basic concepts in meta-analysis: A primer for clinicians. Int J Clin Pract, 2006. 60: p. 1287-94.
Schwab, C.W., Jr., et al., Spontaneous resolution of vesicoureteral reflux: a 15-year perspective. J Urol, 2002. 168: p. 2594-9.
Sjöström, S., et al., Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate and multivariate analyses. J Urol, 2010. 183: p. 1177-84.
Arlen, A.M., et al., Spontaneous vesicoureteral reflux resolution curves based on ureteral diameter ratio. J Pediatr Urol, 2023. 19: p. 468.e1-468.e6.
Garcia-Roig, M., et al., Vesicoureteral Reflux Index: Predicting Primary Vesicoureteral Reflux Resolution in Children Diagnosed after Age 24 Months. J Urol, 2017. 197: p. 1150-1157.
Sjöström, S., et al., Spontaneous resolution of high grade infantile vesicoureteral reflux. J Urol, 2004. 172: p. 694-8; discussion 699.
Kirsch, A.J., et al., Vesicoureteral reflux index (VURx): a novel tool to predict primary reflux improvement and resolution in children less than 2 years of age. J Pediatr Urol, 2014. 10: p. 1249-54.
Knudson, M.J., et al., Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol, 2007. 178(4 Pt 2): p. 1684-8.
Huang, F.Y. and T.C. Tsai, Resolution of vesicoureteral reflux during medical management in children. Pediatr Nephrol, 1995. 9: p. 715-7.
Arlen, A.M., et al., Validation of the ureteral diameter ratio for predicting early spontaneous resolution of primary vesicoureteral reflux. J Pediatr Urol, 2017. 13: p. 383.e1-383.e6.
Wildbrett, P., et al., Spontaneous vesicoureteral reflux resolution in children: A ten-year single-centre experience. Afr J Paediatr Surg, 2013. 10: p. 9-12.
Arsanjani, A. and M. Alagiri, Identification of filling versus voiding reflux as predictor of clinical outcome. Urology, 2007. 70: p. 351-4.
Brock, W.A., et al., Cystitis follicularis in children with primary vesicoureteral reflux. J Urol, 1983. 129: p. 1020-1.
Chang, H.S., K.S. Kim, and I.S. Chung, Congenital small kidney can be an indicator of surgical treatment in children with primary vesicoureteral reflux. Urology, 2009. 74: p. 588-91.
Zerati Filho, M., et al., Spontaneous resolution rates of vesicoureteral reflux in Brazilian children: a 30-year experience. Int Braz J Urol, 2007. 33: p. 204-12; discussion 213-5.
Fukui, S., M. Watanabe, and K. Yoshino, Intrarenal reflux in primary vesicoureteral reflux. Int J Urol, 2013. 20: p. 631-6.
Greenfield, S.P., M. Ng, and J. Wan, Resolution rates of low grade vesicoureteral reflux stratified by patient age at presentation. J Urol, 1997. 157: p. 1410-3.
Kakizaki, H., et al., Clinical features of vesicoureteral reflux in infants and outcome of conservative therapeutic approach. Eur Urol, 1998. 34: p. 221-5.
Upadhyay, J., et al., Natural history of neonatal reflux associated with prenatal hydronephrosis: long-term results of a prospective study. J Urol, 2003. 169: p. 1837-41; discussion 1841; author reply 1841.
Afshar, K., et al., Should the presence of congenital para-ureteral diverticulum affect the management of vesicoureteral reflux? J Urol, 2005. 174(4 Pt 2): p. 1590-3.
Neel, K.F. and J.F. Shillinger, The prevalence of persistent vesicoureteral reflux after 1 negative nuclear medicine cystogram. J Urol, 2000. 164(3 Pt 2): p. 1067-9.
Nepple, K.G., et al., The prognostic impact of an abnormal initial renal ultrasound on early reflux resolution. J Pediatr Urol, 2011. 7: p. 462-6.
Nepple, K.G., et al., Abnormal renal scans and decreased early resolution of low grade vesicoureteral reflux. J Urol, 2008. 180(4 Suppl): p. 1643-7; discussion 1647.
Nepple, K.G., et al., Adding renal scan data improves the accuracy of a computational model to predict vesicoureteral reflux resolution. J Urol, 2008. 180(4 Suppl): p. 1648-52; discussion 1652.
Papachristou, F., et al., Urinary bladder volume and pressure at reflux as prognostic factors of vesicoureteral reflux outcome. Pediatr Radiol, 2004. 34: p. 556-9.
Papachristou, F., et al., The characteristics and outcome of primary vesicoureteric reflux diagnosed in the first year of life. Int J Clin Pract, 2006. 60: p. 829-34.
Payza, A.D., et al., Can distal ureteral diameter measurement predict primary vesicoureteral reflux clinical outcome and success of endoscopic injection? J Pediatr Urol, 2019. 15: p. 515.e1-515.e8.
Peppas, D.S., et al., Nonsurgical management of primary vesicoureteral reflux in complete ureteral duplication: is it justified? J Urol, 1991. 146: p. 1594-5.
Vachvanichsanong, P., et al., Outcome of conservative treatment of primary vesicoureteral reflux in 87 Thai children in a single center. Int J Urol, 2006. 13: p. 1393-7.
Prisca, R.A., et al., Parent compliance: a bad predictor of resolution and a problem in the application of EAU guidelines on vesicoureteral reflux in children. Int Urol Nephrol, 2017. 49: p. 741-745.
Weiss, R., J. Duckett, and A. Spitzer, Results of a randomized clinical trial of medical versus surgical management of infants and children with grades III and IV primary vesicoureteral reflux (United States). The International Reflux Study in Children. J Urol, 1992. 148(5 Pt 2): p. 1667-73.
Zee, R.S., et al., Time to resolution: A prospective evaluation from the Society for Fetal Urology hydronephrosis registry. J Pediatr Urol, 2017. 13: p. 316 e1-316 e5.
Sarhan, O., et al., Critical analysis of the outcome of primary unilateral vesicoureteral reflux in a medium volume center. African Journal of Urology, 2020. 26: p. 49.
Lee, S.J. and J.W. Lee, Probiotics prophylaxis in infants with primary vesicoureteral reflux. Pediatr Nephrol, 2015. 30: p. 609-13.
Penido Silva, J.M., et al., Clinical course of prenatally detected primary vesicoureteral reflux. Pediatr Nephrol, 2006. 21: p. 86-91.
Barthold, J.S., et al., Quantitative nuclear cystography does not predict outcome in patients with primary vesicoureteral reflux. J Urol, 1999. 162(3 Pt 2): p. 1193-6.
Skoog, S.J., A.B. Belman, and M. Majd, A nonsurgical approach to the management of primary vesicoureteral reflux. J Urol, 1987. 138(4 Pt 2): p. 941-6.
Troesch, V.L., et al., The additive impact of the distal ureteral diameter ratio in predicting early breakthrough urinary tract infections in children with vesicoureteral reflux. J Pediatr Urol, 2021. 17: p. 208.e1-208.e5.
Ural, Z., I. Ulman, and A. Avanoglu, Bladder dynamics and vesicoureteral reflux: factors associated with idiopathic lower urinary tract dysfunction in children. J Urol, 2008. 179: p. 1564-7.
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