Priyank Yadav1,2, Mandy Rickard1, Jin Kyu Kim1,3, Juliane Richter1, Marisol Lolas1, Dheidan Alshammari1, Michael E Chua1,4, Joana Dos Santos1, Armando J Lorenzo5,6. 1. Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada. 2. Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. 3. Department of Surgery, University of Toronto, Toronto, ON, Canada. 4. Institute of Urology, St. Luke's Medical Center, Quezon, Philippines. 5. Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada. armando.lorenzo@sickkids.ca. 6. Department of Surgery, University of Toronto, Toronto, ON, Canada. armando.lorenzo@sickkids.ca.
Abstract
OBJECTIVE: To determine through a comprehensive systematic review and meta-analysis the differences in the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) to ascertain if prenatal detection of PUV has superior outcomes. METHODS: We conducted a systematic review and meta-analysis in March 2022 (PROSPERO ID - CRD42021243546) and included all studies that reported outcomes of prenatally and postnatally diagnosed PUV. However, for meta-analysis, only those studies that described both groups were included. The main outcomes of interest included progression of chronic kidney disease (CKD), need for renal replacement therapy (RRT) and renal transplant, and bladder dysfunction as determined by initiation of clean intermittent catheterization (CIC). Time to event analyses were completed when possible. RESULTS: The systematic review included 49 studies (3820 patients). The pooled effect estimates for progression to CKD (OR 0.75 [95% CI 0.43, 1.31]), need for RRT (OR 1.39 [95% CI 0.64, 2.99]) and need for renal transplant (OR 1.64 [95% CI 0.61, 4.42]) between prenatal and postnatal groups was not different. CICs rates were as high as 32% in the prenatal group and 22% in the postnatal group. Most studies had a moderate or serious risk of bias. CONCLUSION: The existing comparative literature on prenatal versus postnatal presentation of PUV is very heterogeneous. The diagnostic and treatment protocols have not been reported in majority of the studies. The outcome variables are also reported inconsistently. Based on the current evidence, prenatal diagnosis of PUV does not appear to improve the long-term outcomes of these patients.
OBJECTIVE: To determine through a comprehensive systematic review and meta-analysis the differences in the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) to ascertain if prenatal detection of PUV has superior outcomes. METHODS: We conducted a systematic review and meta-analysis in March 2022 (PROSPERO ID - CRD42021243546) and included all studies that reported outcomes of prenatally and postnatally diagnosed PUV. However, for meta-analysis, only those studies that described both groups were included. The main outcomes of interest included progression of chronic kidney disease (CKD), need for renal replacement therapy (RRT) and renal transplant, and bladder dysfunction as determined by initiation of clean intermittent catheterization (CIC). Time to event analyses were completed when possible. RESULTS: The systematic review included 49 studies (3820 patients). The pooled effect estimates for progression to CKD (OR 0.75 [95% CI 0.43, 1.31]), need for RRT (OR 1.39 [95% CI 0.64, 2.99]) and need for renal transplant (OR 1.64 [95% CI 0.61, 4.42]) between prenatal and postnatal groups was not different. CICs rates were as high as 32% in the prenatal group and 22% in the postnatal group. Most studies had a moderate or serious risk of bias. CONCLUSION: The existing comparative literature on prenatal versus postnatal presentation of PUV is very heterogeneous. The diagnostic and treatment protocols have not been reported in majority of the studies. The outcome variables are also reported inconsistently. Based on the current evidence, prenatal diagnosis of PUV does not appear to improve the long-term outcomes of these patients.
Authors: A El-Ghoneimi; A Desgrippes; D Luton; M A Macher; J Guibourdenche; C Garel; F Muller; E Vuillard; H Lottmann; C Nessmann; J F Oury; Y Aigrain Journal: J Urol Date: 1999-09 Impact factor: 7.450
Authors: Priyank Yadav; Mandy Rickard; John Weaver; Michael Chua; Jin Kyu Kim; Adree Khondker; Karen Milford; Daniel T Keefe; Marisol Lolas; Joana Dos Santos; Lauren Erdman; Marta Skreta; Antoine Fermin Selman; Eran Ashwal; Bernarda Viteri; Greg Ryan; Gregory Tasian; Armando J Lorenzo Journal: BJU Int Date: 2022-03-18 Impact factor: 5.969
Authors: M A Vasconcelos; A C Simões E Silva; C S Dias; I R Gomes; R A Carvalho; S V Figueiredo; T R Dumont; M C L Oliveira; S V Pinheiro; R H Mak; E A Oliveira Journal: J Pediatr Urol Date: 2018-11-24 Impact factor: 1.830
Authors: Rachel K Morris; Gemma L Malin; Elisabeth Quinlan-Jones; Lee J Middleton; Karla Hemming; Danielle Burke; Jane P Daniels; Khalid S Khan; Jon Deeks; Mark D Kilby Journal: Lancet Date: 2013-08-14 Impact factor: 79.321