Assessing the risk of voiding dysfunction in children with ureteroceles: A systematic review and meta-analysis

Ureterocele is a congenital anomaly potentially associated with voiding dysfunction (VD), often requiring surgical intervention. While surgery aims to relieve obstruction and preserve renal function, postoperative VD and related complications remain significant concerns.

This systematic review aims to evaluate the prevalence of VD and associated outcomes in children following ureterocele surgery.

A systematic search of Medline, Embase, and Web of Science identified studies reporting VD (lower urinary tract dysfunction/symptoms) or related outcomes in children undergoing ureterocele interventions. Random effects meta-analysis was performed to calculate pooled prevalence rates for VD, incontinence, elevated post-void residuals (PVR), and recurrent UTIs. Heterogeneity was assessed using I² statistics, and publication bias was evaluated with funnel plots and trim-and-fill analyses.

Fourteen retrospective studies including 1266 patients were analyzed. VD was reported in 25 % of patients (95 % CI 15-36 %), with significant heterogeneity (I² = 91.2 %). Incontinence occurred in 11 % (95 % CI 6-18 %), and elevated PVR were present in 20 % (95 % CI 7-38 %). Recurrent UTIs occurred in 22 %, but febrile UTIs were lower at 9 % (95 % CI 5-14 %), with minimal heterogeneity (I² = 0 %). Heterogeneity and bias were notable, likely due to varied definitions, surgical techniques, and follow-up durations across studies. Risk of bias was high, especially in domain 1 (bias due to confounding) with high likelihood of publication bias with trim-and-fill analysis suggesting lower rates of VD (8.5 %, 95 % CI 2.5-17.1 %) DISCUSSION: This study has key limitations, including biases from retrospective data, reliance on aggregate outcomes, heterogeneity in definitions and methods, and possible reporting biases. As children in this systematic review have undergone interventions, it is difficult to ascertain whether VD is attributable to congenital patient factors or more influenced by surgical technique. Despite this, the review provides a highest level of summary of voiding dysfunction prevalence in children with ureterocele.

Within limitation of current evidence, there is notable prevalence of postoperative voiding dysfunction and incontinence in children undergoing ureterocele surgery. The findings emphasize the need for standardized definitions and prospective studies to better characterize long-term outcomes and improve clinical decision-making for this population.