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).
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].
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
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)
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Published online: February 22, 2023
Accepted: February 11, 2023
Received in revised form: February 9, 2023
Received: November 29, 2022
Publication stageIn Press Journal Pre-Proof
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- 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.
- Reply to Editorial Comment re ‘Primary Ablation versus Urinary Diversion in Posterior Urethral Valve: Systematic Review and Meta-analysis’Journal of Pediatric Urology