Dextranomer/hyaluronic acid for pediatric vesicoureteral reflux: systematic review
Jonathan C Routh1, Brant A Inman, Yuri Reinberg
1Children's Hospital Boston, Department of Urology, Boston, MA 02115, USA. jon.routh@gmail.com
Insights
Dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) shows a 77% success rate, but outcomes vary. Higher VUR grade negatively impacts success, while other factors like age and COI disclosure are not significant. Further research is needed.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Medical Device Technology
Background:
- Pediatric vesicoureteral reflux (VUR) is a common condition requiring effective treatment.
- Dextranomer/hyaluronic acid (Dx/HA) injection is a minimally invasive option for VUR.
- Reported success rates for Dx/HA injection vary significantly across studies.
Purpose of the Study:
- To investigate the heterogeneity in published success rates of Dx/HA injection for pediatric VUR.
- To identify patient and study-level factors contributing to the variability in Dx/HA treatment outcomes.
Main Methods:
- Comprehensive literature search of multiple databases (1990-2008).
- Duplicate assessment and data abstraction of identified studies.
- Meta-regression analysis to adjust for confounding variables including VUR grade and conflict of interest (COI) disclosure.
Main Results:
- A total of 47 studies with 7303 ureters were included in the pooled analysis.
- The overall per-ureter success rate for Dx/HA injection was 77% at 3 months.
- Preoperative VUR grade was the primary factor influencing success rates; COI disclosure, patient age, and Dx/HA volume were not significant after adjustment.
Conclusions:
- Dx/HA injection demonstrates a 77% success rate for pediatric VUR, but significant heterogeneity exists.
- Higher VUR grade is associated with lower success rates.
- Improved reporting standards and comparative studies are necessary for VUR treatments.
Objective:
Published success rates of dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) vary widely. Our objective of this study was to assess whether underlying patient or study factors could explain the heterogeneity in reported Dx/HA success rates.
Methods:
We searched the Cochrane Controlled Trials Register and Medline, Embase, and Scopus databases from 1990 to 2008 for reports in any language, along with a hand search of included study bibliographies. Articles were assessed and data abstracted in duplicate, and differences were resolved by consensus. Conflict of interest (COI) was determined by published disclosure. Meta-regression was performed to adjust for patient as well as study-level factors.
Results:
We identified 1157 reports, 89 of which were reviewed in full with 47 included in the pooled analysis. Of 7303 ureters that were injected with Dx/HA, 5633 (77%) were successfully treated according to the authors' definition. Injection success seemed to vary primarily on the basis of the preoperative reflux grade. After adjustment for VUR grade, other factors, such as the presence or absence of COI disclosure, were not significant. Studies were markedly heterogeneous overall.
Conclusions:
The overall per-ureter Dx/HA success rate was 77% after 3 months, although success rates varied widely among studies. Increased VUR grade negatively affected success rates, whereas COI, patient age, and injected Dx/HA volume were not significantly associated with treatment outcome after adjustment for VUR grade. There is a significant need for improved reporting of VUR treatments, including comparative studies of Dx/HA and other VUR treatments.
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