Sergio Hernando Mina-Riascos1,2, Nicolas Fernández3, Herney Andrés García-Perdomo4,5. 1. Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia. 2. UROGIV Research Group, School of Medicine, Universidad del Valle, Cll 4B # 36-00, Cali, Colombia. 3. Division of Urology, Seattle Children's Hospital, The University of Washington, Seattle, WA, USA. 4. Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia. herney.garcia@correounivalle.edu.co. 5. UROGIV Research Group, School of Medicine, Universidad del Valle, Cll 4B # 36-00, Cali, Colombia. herney.garcia@correounivalle.edu.co.
Abstract
The purpose of this study is to determine the effectiveness and safety of endoscopic management compared to ureterovesical reimplantation in pediatric patients with high-grade vesicoureteral reflux in terms of urinary tract infection. We performed a network meta-analysis. We searched in MEDLINE, EMBASE, LILACS, and CENTRAL. We included clinical experiments, quasi-experiments, and cohorts studies. The population was men and women between 1 month and 15 years old. Patients had primary high-grade VUR diagnosed by voiding cystourethrography. The interventions were subureteric bulking agent endoscopic injection (polytetrafluoroethylene, hyaluronic acid, collagen, Dx/Ha, and PPC) vs vesicoureteral reimplantation (Cohen, Politano-Leadbetter, Glenn-Anderson, and Lich-Gregoir), and the primary outcome was urinary infections. Nine studies accomplished the inclusion criteria (seven observational and two clinical experiments). A total of 1448 renal units underwent surgical treatments for the correction of high-grade VUR. Regarding the primary outcome, we compared Dx/Ha with Cohen, Lich-Gregoir, and PPC, finding an RD of -0.02 (95%CI -0.09 to 0.06), RD of -0.02 (95%CI -0.10 to 0.07), and an RD of -0.03 (- 0.13 to 0.07), respectively. Conclusion: Our study showed that there were no differences in UTI episodes after VUR correction in patients undergoing endoscopic management compared with vesicoureteral reimplantation. What is Known: • Primary vesicoureteral reflux is one of the most common congenital anomalies of the urinary tract. • The clinical practice guidelines recommend the surgical management of patients with high-grade VUR. What is New: • There were no differences in UTI episodes after VUR correction in patients undergoing endoscopic management compared with vesicoureteral reimplantation.
The purpose of this study is to determine the effectiveness and safety of endoscopic management compared to ureterovesical reimplantation in pediatric patients with high-grade vesicoureteral reflux in terms of urinary tract infection. We performed a network meta-analysis. We searched in MEDLINE, EMBASE, LILACS, and CENTRAL. We included clinical experiments, quasi-experiments, and cohorts studies. The population was men and women between 1 month and 15 years old. Patients had primary high-grade VUR diagnosed by voiding cystourethrography. The interventions were subureteric bulking agent endoscopic injection (polytetrafluoroethylene, hyaluronic acid, collagen, Dx/Ha, and PPC) vs vesicoureteral reimplantation (Cohen, Politano-Leadbetter, Glenn-Anderson, and Lich-Gregoir), and the primary outcome was urinary infections. Nine studies accomplished the inclusion criteria (seven observational and two clinical experiments). A total of 1448 renal units underwent surgical treatments for the correction of high-grade VUR. Regarding the primary outcome, we compared Dx/Ha with Cohen, Lich-Gregoir, and PPC, finding an RD of -0.02 (95%CI -0.09 to 0.06), RD of -0.02 (95%CI -0.10 to 0.07), and an RD of -0.03 (- 0.13 to 0.07), respectively. Conclusion: Our study showed that there were no differences in UTI episodes after VUR correction in patients undergoing endoscopic management compared with vesicoureteral reimplantation. What is Known: • Primary vesicoureteral reflux is one of the most common congenital anomalies of the urinary tract. • The clinical practice guidelines recommend the surgical management of patients with high-grade VUR. What is New: • There were no differences in UTI episodes after VUR correction in patients undergoing endoscopic management compared with vesicoureteral reimplantation.