Journal of pediatric urology · 2025
New-onset contralateral vesicoureteral reflux after unilateral endoscopic treatment of primary vesicoureteral reflux with Dextranomer/Hyaluronic acid copolymer: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Chandrasekharam V V S, Babu Ramesh
Аннотация
INTRODUCTION: Endoscopic treatment (ET) with Dextranomer/Hyaluronic Acid (DxHA) has gained popularity as a minimally invasive option of vesicoureteral reflux (VUR). However, new-onset contralateral VUR (NCVUR) after unilateral ET remains a concern. This systematic review and meta-analysis (SR/MA) aimed to determine the incidence, severity, and clinical significance of NCVUR and explore whether prophylactic treatment of the non-refluxing contralateral ureter is warranted.
METHODS: Databases including PubMed were searched for studies (2001-2024) reporting NCVUR after unilateral ET with DxHA. Inclusion criteria encompassed English-language original studies on children undergoing unilateral ET. Studies with other bulking agents, bilateral treatment, or selection bias were excluded. Risk of bias was assessed using ROBVIS 2.0, and a meta-analysis of proportions was performed using MetaXL 5.3.
RESULTS: Seven studies (n = 1479 patients) met inclusion criteria. The pooled incidence of NCVUR was 10 % (95 % CI: 8-12 %). Heterogeneity was low to moderate (I2 = 29 %). Among NCVUR cases (n = 148), 62 % were low grade (I-II), 32 % grade III, and only 6 % grade IV; no grade V cases were reported. Only 51 % of NCVUR underwent further ET. Prophylactic contralateral ET based on cystoscopic findings did not consistently reduce NCVUR incidence. Hydrodistention grading and ureteral orifice configuration failed to reliably predict NCVUR risk.
DISCUSSION: NCVUR is a known occurrence following both open surgery and ET for unilateral VUR. While earlier studies raised concerns about the potential morbidity of NCVUR, this meta-analysis suggests that most cases are low grade and clinically insignificant. Importantly, prophylactic injection of the contralateral ureter, based on intraoperative findings, appears to offer limited benefit and may lead to overtreatment. Among patients who received prophylactic DxHA injection, the incidence of NCVUR was similar to those managed conservatively. This analysis also found no consistent preoperative or intraoperative predictors for NCVUR. Given the low clinical impact of most NCVUR and the cost implications of DxHA, routine prophylactic treatment of a non-refluxing contralateral ureter is not justified. Future research should focus on long-term outcomes and patient-centered metrics such as UTI recurrence and need for re-intervention.
CONCLUSIONS: This SR/MA found 10 % incidence of NCVUR following ET with DxHA for unilateral VUR. Most cases of NCVUR were low grade VUR. Neither pre-operative factors nor intraoperative cystoscopic assessment of the contralateral UO could predict the risk of future development of NCVUR. Currently there seems to be no role for prophylactic injection of contralateral ureters based on intraoperative cystoscopic assessment.
METHODS: Databases including PubMed were searched for studies (2001-2024) reporting NCVUR after unilateral ET with DxHA. Inclusion criteria encompassed English-language original studies on children undergoing unilateral ET. Studies with other bulking agents, bilateral treatment, or selection bias were excluded. Risk of bias was assessed using ROBVIS 2.0, and a meta-analysis of proportions was performed using MetaXL 5.3.
RESULTS: Seven studies (n = 1479 patients) met inclusion criteria. The pooled incidence of NCVUR was 10 % (95 % CI: 8-12 %). Heterogeneity was low to moderate (I2 = 29 %). Among NCVUR cases (n = 148), 62 % were low grade (I-II), 32 % grade III, and only 6 % grade IV; no grade V cases were reported. Only 51 % of NCVUR underwent further ET. Prophylactic contralateral ET based on cystoscopic findings did not consistently reduce NCVUR incidence. Hydrodistention grading and ureteral orifice configuration failed to reliably predict NCVUR risk.
DISCUSSION: NCVUR is a known occurrence following both open surgery and ET for unilateral VUR. While earlier studies raised concerns about the potential morbidity of NCVUR, this meta-analysis suggests that most cases are low grade and clinically insignificant. Importantly, prophylactic injection of the contralateral ureter, based on intraoperative findings, appears to offer limited benefit and may lead to overtreatment. Among patients who received prophylactic DxHA injection, the incidence of NCVUR was similar to those managed conservatively. This analysis also found no consistent preoperative or intraoperative predictors for NCVUR. Given the low clinical impact of most NCVUR and the cost implications of DxHA, routine prophylactic treatment of a non-refluxing contralateral ureter is not justified. Future research should focus on long-term outcomes and patient-centered metrics such as UTI recurrence and need for re-intervention.
CONCLUSIONS: This SR/MA found 10 % incidence of NCVUR following ET with DxHA for unilateral VUR. Most cases of NCVUR were low grade VUR. Neither pre-operative factors nor intraoperative cystoscopic assessment of the contralateral UO could predict the risk of future development of NCVUR. Currently there seems to be no role for prophylactic injection of contralateral ureters based on intraoperative cystoscopic assessment.