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Endoscopic Therapy for Vesicoureteral Reflux: A Meta-Analysis. I. Reflux Resolution and Urinary Tract Infection

2006; Lippincott Williams & Wilkins; Volume: 175; Issue: 2 Linguagem: Inglês

10.1016/s0022-5347(05)00210-7

1527-3792

Jack S. Elder, Mireya Díaz, Anthony A. Caldamone, Marc Cendron, Saul P. Greenfield, Richard S. Hurwitz, Andrew J. Kirsch, Martin A. Koyle, John Pope, Ellen Shapiro,

Kidney Stones and Urolithiasis Treatments

No AccessJournal of UrologyPediatric urology1 Feb 2006Endoscopic Therapy for Vesicoureteral Reflux: A Meta-Analysis. I. Reflux Resolution and Urinary Tract Infection Jack S. Elder, Mireya Diaz, Anthony A. Caldamone, Marc Cendron, Saul Greenfield, Richard Hurwitz, Andrew Kirsch, Martin A. Koyle, John Pope, and Ellen Shapiro Jack S. ElderJack S. Elder Division of Pediatric Urology, Rainbow Babies and Children’s Hospital Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio Financial interest and/or other relationship with QMed, Watson and Silimed. More articles by this author , Mireya DiazMireya Diaz Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio More articles by this author , Anthony A. CaldamoneAnthony A. Caldamone Divisions of Pediatric Urology, Hasbro Children’s Hospital, Providence, Rhode Island Financial interest and/or other relationship with Mentor, QMed and Aventis. More articles by this author , Marc CendronMarc Cendron Children’s Hospital, Boston, Massachusetts More articles by this author , Saul GreenfieldSaul Greenfield Women and Children’s Hospital, Buffalo More articles by this author , Richard HurwitzRichard Hurwitz New York, Kaiser-Permanente, Los Angeles, California More articles by this author , Andrew KirschAndrew Kirsch Children’s Healthcare Group, Atlanta, Georgia Financial interest and/or other relationship with QMed Scandinavia. More articles by this author , Martin A. KoyleMartin A. Koyle Denver Children’s Hospital, Denver, Colorado Financial interest and/or other relationship with QMed, Mentor, Watson and Cook. More articles by this author , John PopeJohn Pope Vanderbilt Children’s Hospital, Nashville, Tennessee More articles by this author , and Ellen ShapiroEllen Shapiro New York University School of Medicine, New York More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00210-7AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Current American Urological Association treatment guidelines for vesicoureteral reflux do not include any recommendations pertaining to endoscopic therapy (subureteral injection of bulking agent). We performed a meta-analysis of the existing literature pertaining to endoscopic treatment to allow comparison with reports of open surgical correction. Materials and Methods: We searched all peer reviewed articles published through 2003 pertaining to endoscopic treatment of vesicoureteral reflux. A total of 63 articles were double reviewed by 9 pediatric urologists, and the data were tabulated on data retrieval sheets. A mixed effects logistic regression model was used to obtain overall estimates of event probabilities (eg reflux resolution, ureteral obstruction) together with their 95% confidence intervals. Individual study estimates were obtained with overall estimate and observation characteristics using empirical Bayes calculations. Differences between or among specific groups were assessed using the F-test. Results: The database included 5,527 patients and 8,101 renal units. Following 1 treatment the reflux resolution rate (by ureter) for grades I and II reflux was 78.5%, grade III 72%, grade IV 63% and grade V 51%. If the first injection was unsuccessful, the second treatment had a success rate of 68%, and the third treatment 34%. The aggregate success rate with 1 or more injections was 85%. The success rate was significantly lower for duplicated (50%) vs single systems (73%), and neuropathic (62%) vs normal bladders (74%). The success rate was similar among children and adults. Following a previous failed open reimplantation endoscopic treatment was successful in 65% of patients. After endoscopic treatment with variable followup pyelonephritis developed in 0.75% of patients and cystitis in 6%. There were few reports of renal scarring following treatment. Conclusions: Endoscopic treatment provides a high rate of success in children with reflux that decreases with increasing grade, although multiple treatments may be necessary. Future reports of endoscopic therapy should include rates of urinary tract infection and renal scarring. References 1 : Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol1997; 157: 1846. 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Elder Division of Pediatric Urology, Rainbow Babies and Children’s Hospital Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio Financial interest and/or other relationship with QMed, Watson and Silimed. More articles by this author Mireya Diaz Department of Urology, Case Western Reserve University School of Medicine, Cleveland, Ohio More articles by this author Anthony A. Caldamone Divisions of Pediatric Urology, Hasbro Children’s Hospital, Providence, Rhode Island Financial interest and/or other relationship with Mentor, QMed and Aventis. More articles by this author Marc Cendron Children’s Hospital, Boston, Massachusetts More articles by this author Saul Greenfield Women and Children’s Hospital, Buffalo More articles by this author Richard Hurwitz New York, Kaiser-Permanente, Los Angeles, California More articles by this author Andrew Kirsch Children’s Healthcare Group, Atlanta, Georgia Financial interest and/or other relationship with QMed Scandinavia. More articles by this author Martin A. Koyle Denver Children’s Hospital, Denver, Colorado Financial interest and/or other relationship with QMed, Mentor, Watson and Cook. More articles by this author John Pope Vanderbilt Children’s Hospital, Nashville, Tennessee More articles by this author Ellen Shapiro New York University School of Medicine, New York More articles by this author Expand All Advertisement PDF downloadLoading ...