[Updated analysis of the efficacy of therapeutic options in primary vesicoureteral reflux].
OBJECTIVE
The primary objective of this study is to perform a systematic review of the therapeutic management of primary VUR in pediatric urology.


METHODS
A systematic review of the articles published in all of the available databases has been performed, including scientific evidence-based medicine criteria. Inclusion criteria concerning basic quality of the articles were considered essential, as well as exclusion criteria to be able to reject the articles.


RESULTS
A critic reading of selected articles, and statistical study of grouped data was performed according to the type of treatment and benefits contributed by each treatment, and also to their undesirable effects.


CONCLUSIONS
The following Conclusions were drawn from the results obtained and from the analysis of the texts. Both medical and surgical treatment present similar effectiveness concerning resolution of grades I, II and III VUR, and the former one is the recommended initial treatment following diagnosis. Endoscopic treatment is exactly as effective as open surgery for grades I, II and III with fewer undesirable secondary effects. There are no differences concerning the efficacy of the different injected substances. Not enough evidences exist for degrees IV and V that may recommend or advise against any of the treatments. In any degree of VUR, open surgical treatment is superior as far as medical treatment is concerned only regarding the number of acute pyelonephritis episodes during follow-up. This conclusion cannot be applied on endoscopic treatment.
Alvarez Ardura
Manuel
M
Servicio de Urología, Fundación Hospital Alcorcón, Madrid, España. malvareza@fhalcorcon.es
De la Peña Zarzuelo
Enrique
E
Hernández Cañas
Virginia
V
Amaruch García
Nasser
N
de la Morena Gallego
José Manuel
JM
Llorente Abarca
Carlos
C
D002921:Cicatrix / Q000209:etiology / Q000628:therapy; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D014552:Urinary Tract Infections / Q000209:etiology / Q000628:therapy; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000628:therapy*