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Effectiveness and risks of endoscopic management compared to vesicoureteral reimplantation in patients with high-grade vesicoureteral reflux: systematic review and network meta-analysis

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An Editorial to this article was published on 19 February 2021

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.

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Data availability

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Abbreviations

VUR:

Primary vesicoureteral reflux

UTI:

Urinary tract infection

Dx/Ha:

Dextranomer/hyaluronic acid copolymer

PPC:

Polyalcohol polyacrylate copolymer

DeCS:

Descriptors in health sciences

MINORS:

Methodological index for non-randomized studies

RR:

Relative risk

ALARA:

As low as reasonably achievable

MIS:

Minimally invasive surgery

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Authors and Affiliations

  1. Department of Surgery/Urology, School of Medicine, Universidad del Valle, Cali, Colombia

    Sergio Hernando Mina-Riascos & Herney Andrés García-Perdomo

  2. UROGIV Research Group, School of Medicine, Universidad del Valle, Cll 4B # 36-00, Cali, Colombia

    Sergio Hernando Mina-Riascos & Herney Andrés García-Perdomo

  3. Division of Urology, Seattle Children’s Hospital, The University of Washington, Seattle, WA, USA

    Nicolas Fernández

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  1. Sergio Hernando Mina-Riascos
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Contributions

All three authors (SM, HAG, NF) participated in all steps of this research: idea/concept, protocol, running the strategies, extracting data, statistical analysis, discussing the results, writing the manuscript draft, and approval of the final manuscript.

SM participated in all steps of this research: idea/concept, protocol, running the strategies, extracting data, statistical analysis, discussing the results, writing the manuscript draft, and approval of the final manuscript.

NF participated in all steps of this research: idea/concept, protocol, running the strategies, extracting data, statistical analysis, discussing the results, writing the manuscript draft, and approval of the final manuscript.

HAGP participated in all steps of this research: idea/concept, protocol, running the strategies, extracting data, statistical analysis, discussing the results, writing the manuscript draft, and approval of the final manuscript.

Corresponding author

Correspondence to Herney Andrés García-Perdomo.

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The authors declare that they have no conflict of interest.

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This research accomplishes with all the international requirements for ethics in research. This article does not contain any studies with human participants or animals performed by any of the authors.

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Communicated by Gregorio Paolo Milani

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Appendix. Search strategy

Appendix. Search strategy

MEDLINE (OVID)

(Exp Vesico Ureteral Reflux or (Vesico*ureteral adj2 Reflux).mp or VUR.mp or (Vesico*ureteric reflux).mp) AND (Reimplantation*.mp or (subureteric adj2 implantation).mp or (subureteric adj2 injection).mp or vantris.mp or polytetrafluoroethylene.mp or hyaluronic adj2 acid or collagen.mp or deflux.mp) or (politano*leadbetter).mp or (Glenn*anderson).mp or cohen.mp or (lich*gregoir).mp) AND (randomized controlled trial.pt or controlled clinical trial.pt or randomized.ab or placebo.ab or randomly.ab or trial.ab or (clinical adj2 trial).mp or (randomi*ed adj2 controlled adj2 trial).mp or exp double-blind method or clinical trial.pt or exp Non-Randomized Controlled Trials or (quasi adj2 experiment*).mp or exp cohort studies or cohort*.mp)

EMBASE (Scopus)

TITLE-ABS-KEY(“Vesico Ureteral Reflux” or VUR or “Vesico*ureteric reflux”) AND TITLE-ABS-KEY(“Reimplantation*” or “subureteric implantation” or “subureteric injection” or vantris or polytetrafluoroethylene or “hyaluronic acid” or collagen or deflux or “politano*leadbetter” or “Glenn*anderson” or cohen or “lich*gregoir”) AND TITLE-ABS-KEY(“randomized controlled trial” or “controlled clinical trial” or randomized or placebo or randomly or trial or “clinical trial” or “double-blind method” or “Non-Randomized Controlled Trials” or “quasi experiment*” or “cohort stud*” or “cohort*”)

CENTRAL

(Exp Vesico Ureteral Reflux or (Vesico*ureteral adj2 Reflux).mp or VUR.mp or (Vesico*ureteric reflux).mp) AND (Reimplantation*.mp or (subureteric adj2 implantation).mp or (subureteric adj2 injection).mp or vantris.mp or polytetrafluoroethylene.mp or hyaluronic adj2 acid or collagen.mp or deflux.mp) or (politano*leadbetter).mp or (Glenn*anderson).mp or cohen.mp or (lich*gregoir).mp)

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Mina-Riascos, S.H., Fernández, N. & García-Perdomo, H.A. Effectiveness and risks of endoscopic management compared to vesicoureteral reimplantation in patients with high-grade vesicoureteral reflux: systematic review and network meta-analysis. Eur J Pediatr 180, 1383–1391 (2021). https://doi.org/10.1007/s00431-021-03948-w

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