Comparative Analysis of Ureteral Reimplantation and Dextranomer/Hyaluronic Acid Injection Between Two Centers With Systematic Review and Meta-Analysis.

PURPOSE: Surgical management of pediatric vesicoureteral reflux aims to reduce febrile UTIs while minimizing perioperative morbidity. We compared dextranomer/hyaluronic acid (Dx/HA) injection with ureteral reimplantation, focusing on durability, infectious outcomes, and perioperative burden.

MATERIALS AND

METHODS

We conducted an era-matched and indication-matched retrospective 2-center cohort study (January 2018-December 2025) of children < 18 years treated for recurrent UTIs with Dx/HA or reimplantation, alongside a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review and meta-analysis (MEDLINE, Embase, Scopus; inception to December 2025; PROSPERO CRD420251154210). Outcomes included radiographic resolution, reoperation, postoperative febrile UTIs, operative time, and length of stay. Random-effects models were used; heterogeneity was assessed with tau2 and bias with RoB 2.0/ROBINS-I.

RESULTS

Institutional cohorts included 179 Dx/HA and 130 reimplantations. Dx/HA had shorter operative time (21 vs 140 minutes; P < .001) and length of stay (0 vs 1 day; P < .001). Thirty-day emergency department visits, readmissions, non-UTI complications, and redo surgery did not differ (all P > .2). Postoperative UTI (19.6% vs 3.8%; P < .001) and recurrent UTI (11.7% vs 1.5%; P < .001) were higher after Dx/HA; procedure type independently predicted UTI (HR 5.6, 95% CI 2.1-14.6; P < .001). Meta-analysis (15 studies) favored reimplantation for radiographic resolution (risk ratio for nonresolution 4.30; P = .0003; tau2 = 0.44) and reoperation (risk ratio 6.42; P < .00001; tau2 = 0.20), while febrile/recurrent UTI did not differ (tau2 = 1.12). Evidence certainty was limited by heterogeneity and predominantly nonrandomized data.

CONCLUSIONS

Ureteral reimplantation has lower likelihood of reoperation and with possibly postoperative UTI risk, while Dx/HA offers meaningful perioperative advantages. These trade-offs support individualized, risk-adapted surgical decision-making for pediatric vesicoureteral reflux.