부산대학교 도서관

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 nom- ogram 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 Assess- ment 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 clini- cians 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 addi- tional factors within larger populations to enhance our understanding of primary VUR resolution dynamics. [ABSTRACT FROM AUTHOR]