Summary
Purpose
To determine differences in long-term kidney and bladder outcomes in boys with posterior
urethral valves (PUV) managed by a primary valve ablation or primary urinary diversion.
Materials and methods
A systematic search was performed in March 2021. Comparative studies were evaluated
according to Cochrane collaboration recommendations. Assessed measures included kidney
outcomes (chronic kidney disease, end-stage renal disease, kidney function) and bladder
outcomes. Odds ratios (OR) and mean difference (MD) with 95% confidence interval (CI)
were extrapolated from available data for quantitative synthesis. Random-effects meta-analysis
and meta-regression were performed according to study design, and potential covariates
were assessed with subgroup analysis. The systematic review was prospectively registered
on PROSPERO (CRD42021243967).
Results
Thirty unique studies describing 1547 boys with PUV were included in this synthesis.
Overall effect estimates demonstrate that patients undergoing primary diversion have
significantly increased odds of developing renal insufficiency [OR 0.60, 95% CI 0.44,
0.80; p < 0.001]. However, when adjusting for baseline kidney function between intervention
groups, there was no significant difference in long term kidney outcomes [p = 0.09,
0.35], or the development of bladder dysfunction or requiring clean-intermittent catheterization
with primary ablation rather than diversion [OR 0.89, 95% CI 0.49, 1.59; p = 0.68].
Conclusions
Current low-quality evidence suggests that medium-term kidney outcomes in children
are similar between primary ablation and primary diversion after adjusting for baseline
kidney function, while bladder outcomes are highly heterogenous. Further research
with covariate control is warranted to investigate sources of heterogeneity.
Level of evidence
Level III.
Keywords
Abbreviations:
CI (Confidence interval), CIC (Clean intermittent catheterization), ESRD (End-stage renal disease), GFR (Glomerular filtration rate), MD (Mean difference), OR (Odds ratio), PUV (Posterior urethral valve), SCr (Serum creatinine)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 22, 2023
Accepted:
February 11,
2023
Received in revised form:
February 9,
2023
Received:
November 29,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Re: Primary Ablation versus Urinary Diversion in Posterior Urethral Valve: Systematic Review and Meta-analysisJournal of Pediatric Urology
- PreviewIn this systematic review, the authors investigate the controversial topic of whether primary valve ablation or vesicostomy yields superior long-term outcomes in children with PUV [ ]. While the review itself is nicely conducted, it should be emphasized that all 30 studies included in the review have moderate or severe risk of bias. The conclusions founded from these studies should be interpreted cautiously.
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- Reply to Editorial Comment re ‘Primary Ablation versus Urinary Diversion in Posterior Urethral Valve: Systematic Review and Meta-analysis’Journal of Pediatric Urology
