Comparison between cystostomy with delayed resection and isolated endoscopic resection in posterior urethral valve treatment: A meta-analysis of renal outcomes in children
DOI:
https://doi.org/10.33448/rsd-v14i6.49095Keywords:
Posterior urethral valves, End-stage renal disease, Endoscopic resection, Cystostomy, Meta-analysis.Abstract
The objective of this study was to perform a meta-analysis to compare ESRD outcomes, measured by GFR, in children with PUV treated with two distinct therapeutic strategies: CT followed by delayed resection (DR) and REI. This meta-analysis compared cystostomy with delayed resection (CTRT) and isolated endoscopic resection (REI) in preventing end-stage renal disease (ESRD) in children with posterior urethral valves (PUV). Twelve studies (2011–2023) involving 770 patients were analyzed after screening 1,904 records. Results showed 29.28% of CTRT patients progressed to ESRD versus 18.15% in the REI group, but without statistical significance (absolute difference: -11.13%; 95% CI: -33.50% to 11.25%; *p* = 0.306). Both approaches demonstrated similar efficacy, with the choice depending on obstruction severity, healthcare resources, and surgeon expertise. CTRT may be preferable in resource-limited settings, while REI is feasible in specialized centers. Study limitations included heterogeneity and lack of data on PUV severity. The findings support individualized treatment and highlight the need for long-term follow-up studies.
References
Al Hussein Al Awamlh, B., Wang, L. C., Nguyen, D. P., Rieken, M., Lee, R. K., Lee, D. J., Flynn, T., Chrystal, J., Shariat, S. F., & Scherr, D. S. (2015). Is continent cutaneous urinary diversion a suitable alternative to orthotopic bladder substitute and ileal conduit after cystectomy? BJU International, 116(5), 805–814. https://doi.org/10.1111/bju.12919
Al-Salem, A. H. (2014). Posterior Urethral Valve. Em A. H. Al-Salem, An Illustrated Guide to Pediatric Surgery (p. 569–579). Springer International Publishing. https://doi.org/10.1007/978-3-319-06665-3_70
Alma, E., Ercil, H., Vuruskan, E., Altunkol, A., Unal, U., Gurlen, G., Goren, V., & Gurbuz, Z. G. (2020). Long-term follow-up results and complications in cancer patients with persistent nephrostomy due to malignant ureteral obstruction. Supportive Care in Cancer, 28(11), 5581–5588. https://doi.org/10.1007/s00520-020-05662-z
Anima. (2014). Manual revisão bibliográfica sistemática integrativa: a pesquisa baseada em evidências. Grupo Anima. https://biblioteca.cofen.gov.br/wp-content/uploads/2019/06/manual_revisao_bibliografica-sistematica-integrativa.pdf.
Arlen, A. M. (2022). Transurethral resection of posterior urethral valves. Urology Video Journal, 15, 100165. https://doi.org/10.1016/j.urolvj.2022.100165
Arlen, A. M., & Cooper, C. S. (2015). Controversies in the Management of Vesicoureteral Reflux. Current Urology Reports, 16(9), 64. https://doi.org/10.1007/s11934-015-0538-2
Asanuma, H., & Oya, M. (2016). Suprapubic Cystostomy and Vesicocutaneostomy. Em T. Taguchi, T. Iwanaka, & T. Okamatsu (Orgs.), Operative General Surgery in Neonates and Infants (p. 315–319). Springer Japan. https://doi.org/10.1007/978-4-431-55876-7_51
Athawale, H. R. (2020). Ten years institutional experience with study of prognostic factors affecting renal outcome in children with posterior urethral valves. International Journal of Contemporary Pediatrics, 7(12), 2326. https://doi.org/10.18203/2349-3291.ijcp20205093
Bazerbachi, F., White, R. M., Forbes, N., Goudra, B., Abu Dayyeh, B. K., Chandrasekhara, V., & Sweitzer, B. (2022). Endo-anesthesia: A primer. Gastroenterology Report, 10, goac069. https://doi.org/10.1093/gastro/goac069
Bekman, O. R. & Costa Neto, P. L. O. (2009). Análise estatística da decisão. (2ed.). Ed.
Bhadoo, D., Bajpai, M., & Panda, S. (2014). Posterior urethral valve: Prognostic factors and renal outcome. Journal of Indian Association of Pediatric Surgeons, 19(3), 133. https://doi.org/10.4103/0971-9261.136459
Bilgutay, A. N., Roth, D. R., Gonzales, E. T., Janzen, N., Zhang, W., Koh, C. J., Gargollo, P., & Seth, A. (2016). Posterior urethral valves: Risk factors for progression to renal failure. Journal of Pediatric Urology, 12(3), 179.e1-179.e7. https://doi.org/10.1016/j.jpurol.2015.10.009
Caplin, D. M., Lombardi, P., & Rambhia, S. (2016). Urinary Diversion and Drainage. Em A. R. Rastinehad, D. N. Siegel, P. A. Pinto, & B. J. Wood (Orgs.), Interventional Urology (p. 243–270). Springer International Publishing. https://doi.org/10.1007/978-3-319-23464-9_19
Carpenter, A. R., Becknell, B., Hirselj, D. A., & McHugh, K. M. (2012). Urinary Diversion via Cutaneous Vesicostomy in the Megabladder Mouse. Em O. Michos (Org.), Kidney Development (Vol. 886, p. 393–402). Humana Press. https://doi.org/10.1007/978-1-61779-851-1_34
Cascio, S., Coyle, D., Nappo, S., & Caione, P. (2023). Posterior Urethral Valves. Em P. Puri & M. E. Höllwarth (Orgs.), Pediatric Surgery (p. 1307–1328). Springer International Publishing. https://doi.org/10.1007/978-3-030-81488-5_94
Ceccanti, S., Pepino, D., Giancotti, A., Ricci, E., Piacenti, S., & Cozzi, D. A. (2021). Prolonged Indwelling Urethral Catheterization as Minimally Invasive Approach for Definitive Treatment of Posterior Urethral Valves in Unstable Premature Babies. Children, 8(5), 408. https://doi.org/10.3390/children8050408
Çetin, B., Dönmez, M. İ., Erdem, S., Ziylan, O., & Oktar, T. (2021). Renal, Bladder and Sexual Outcomes in Adult Men with History of Posterior Urethral Valves Treated in Childhood. Urology, 153, 301–306. https://doi.org/10.1016/j.urology.2020.11.002
Chan, E. P., Wang, P. Z. T., & Dave, S. (2020). Valve Bladder Syndrome Associated with Posterior Urethral Valves: Natural History, Work-up, and Management. Current Bladder Dysfunction Reports, 15(2), 76–82. https://doi.org/10.1007/s11884-020-00577-1
Chatterjee, U., Basu, A., & Mitra, D. (2020). Insight into posterior urethral valve from our experience: Paradigm appended to abate renal failure. Journal of Indian Association of Pediatric Surgeons, 25(5), 297. https://doi.org/10.4103/jiaps.JIAPS_136_19
Chua, M. E., Ming, J. M., Carter, S., El Hout, Y., Koyle, M. A., Noone, D., Farhat, W. A., Lorenzo, A. J., & Bägli, D. J. (2018). Impact of Adjuvant Urinary Diversion versus Valve Ablation Alone on Progression from Chronic to End Stage Renal Disease in Posterior Urethral Valves: A Single Institution 15-Year Time-to-Event Analysis. Journal of Urology, 199(3), 824–830. https://doi.org/10.1016/j.juro.2017.10.024
Coyle, D., Nidaw, E., Getachew, H., Payne, S. R., & Subramaniam, R. (2022). Paediatric urology in Sub‐Saharan Africa: Challenges and opportunities. BJU International, 130(3), 277–284. https://doi.org/10.1111/bju.15852
Crossetti, M. G. M. (2012). Revisión integradora de la investigación en enfermería el rigor científico que se le exige.
Divya, G., Kundal, V. K., Addagatla, R., Kumar, R., Jaglan, S. K., Debnath, P. R., Meena, A. K., & Shah, S. (2024). Clinical Profile, Management, and Outcome of Posterior Urethral Valves in Children – Experience from a Tertiary Care Hospital. Journal of Indian Association of Pediatric Surgeons, 29(4), 364–369. https://doi.org/10.4103/jiaps.jiaps_27_24
Edgar Blucher. Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Santa Maria/RS. Editora da UAB/NTE/UFSM.
Fishberg, S. E., Landau, E. H., Duvdevani, M., Gofrit, O. N., Friedman, S. E., & Hidas, G. (2018). Posterior Urethral Valves: Prenatal, Neonatal, and Long-Term Management. NeoReviews, 19(12), e753–e761. https://doi.org/10.1542/neo.19-12-e753
Godlewski, K., Tekgul, S., Gong, E., Vanderbrink, B., & Srinivasan, A. (2024). Clinical considerations in adults with history of posterior urethral valves. Journal of Pediatric Urology, 20(2), 176–182. https://doi.org/10.1016/j.jpurol.2023.09.006
H. Okasha, A., A. Galal, H., & M. Salih, E.-S. (2021). Temporary vesicostomy in children with voiding dysfunction: possible predictors of morphological and functional improvement of upper urinary tract. Al-Azhar Medical Journal, 50(2), 905–914. https://doi.org/10.21608/amj.2021.158294
Hamdi, A., & Das, V. (2015). Insuffisance rénale aiguë obstructive de l’adulte en réanimation: Prise en charge et facteurs pronostiques. Réanimation, 24(6), 661–667. https://doi.org/10.1007/s13546-015-1120-4
Hautmann, R. E. (2015). Techniques of Urinary Diversion. Em H. R. H. Patel, T. Mould, J. V. Joseph, & C. P. Delaney (Orgs.), Pelvic Cancer Surgery (p. 175–184). Springer London. https://doi.org/10.1007/978-1-4471-4258-4_18
Hofmann, A., Haider, M., Cox, A., Vauth, F., & Rösch, W. H. (2022). Is Vesicostomy Still a Contemporary Method of Managing Posterior Urethral Valves? Children, 9(2), 138. https://doi.org/10.3390/children9020138
Khondker, A., Chelliahpillai, Y., Machado, M., Kaab, A., Richter, J., Kim, J. K., Chua, M., Dos Santos, J., Rickard, M., & Lorenzo, A. J. (2024). External validation and reliability assessment of posterior urethral morphology on initial voiding cystourethrogram as a predictor for infants with posterior urethral valves. Journal of Pediatric Urology, 20(2), 253.e1-253.e6. https://doi.org/10.1016/j.jpurol.2023.11.051
Khondker, A., Kim, J. K., Chua, M. E., Kwong, J. C. C., Chan, J. Y. H., Yadav, P., Richter, J., Santos, J. D., Brownrigg, N., Lorenzo, A. J., & Rickard, M. (2023). The effect of primary urinary diversion on kidney function in posterior urethral valve: A matched comparison. Urology, 172, 170–173. https://doi.org/10.1016/j.urology.2022.11.022
Kibar, Y., Ashley, R. A., Roth, C. C., Frimberger, D., & Kropp, B. P. (2011). Timing of posterior urethral valve diagnosis and its impact on clinical outcome. Journal of Pediatric Urology, 7(5), 538–542. https://doi.org/10.1016/j.jpurol.2010.08.002
Liu, V. S., Qureshi, M. A., & Aziz, M. A. (2024). Posterior Urethral Valves in a Healthy-Appearing Athletic Adult: A Case Report. Cureus. https://doi.org/10.7759/cureus.66514
Maria Da Graça Oliveira Crossetti. Rev. Gaúcha Enferm.33(2), 8-9.
Misseri, R., & Rink, R. C. (2014). Continent Urinary Diversion. Em R. Rabinowitz, W. C. Hulbert, & R. A. Mevorach (Orgs.), Pediatric Urology for the Primary Care Physician (p. 295–301). Springer New York. https://doi.org/10.1007/978-1-60327-243-8_36
Mo, Z., Li, M., Xie, X., Sun, N., Zhang, W., Tian, J., & Song, H. (2023a). Urodynamic changes before and after endoscopic valve ablation in boys diagnosed with the posterior urethral valve without chronic renal failure. BMC Urology, 23(1), 5. https://doi.org/10.1186/s12894-022-01170-w
Moomjian, L. N., Carucci, L. R., Guruli, G., & Klausner, A. P. (2016). Follow the Stream: Imaging of Urinary Diversions. RadioGraphics, 36(3), 688–709. https://doi.org/10.1148/rg.2016150180
Nakai, H., Hyuga, T., Kawai, S., Kubo, T., & Nakamura, S. (2017). Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children. Investigative and Clinical Urology, 58(Suppl 1), S46. https://doi.org/10.4111/icu.2017.58.S1.S46
Onur, M. R., Sidhu, R., & Dogra, V. S. (2013). Imaging of Urinary Diversion and Neobladder. Em V. S. Dogra & G. T. MacLennan (Orgs.), Genitourinary Radiology: Male Genital Tract, Adrenal and Retroperitoneum (p. 327–342). Springer London. https://doi.org/10.1007/978-1-4471-4899-9_14
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, n71. https://doi.org/10.1136/bmj.n71
Pedapathnapu, M., Reddy, D. R., Ranga Swamy, A. V., & Guddeti, R. S. (2022). Management of posterior urethral valves- a clinical experience from indian settings. International Journal of Scientific Research, 61–64. https://doi.org/10.36106/ijsr/6007680
Pellegrino, C., Capitanucci, M. L., Forlini, V., Zaccara, A., Lena, F., Sollini, M. L., Castelli, E., & Mosiello, G. (2023). Posterior urethral valves: Role of prenatal diagnosis and long-term management of bladder function; a single center point of view and review of literature. Frontiers in Pediatrics, 10, 1057092. https://doi.org/10.3389/fped.2022.1057092
Rawashdeh, Y. F., Fossum, M., Stein, R., & Chrzan, R. (2024). Expertise Area 1.5: Posterior urethral valves. Em Rare and Complex Urology (p. 129–140). Elsevier. https://doi.org/10.1016/B978-0-323-99934-2.00016-4
Razik, A., Das, C. J., Gupta, A., Wanamacher, D., & Verma, S. (2019). Urinary diversions: A primer of the surgical techniques and imaging findings. Abdominal Radiology, 44(12), 3906–3918. https://doi.org/10.1007/s00261-019-02179-w
Robinson, C. H., Rickard, M., Jeyakumar, N., Smith, G., Richter, J., Van Mieghem, T., Dos Santos, J., Chanchlani, R., & Lorenzo, A. J. (2024). Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study. Journal of the American Society of Nephrology, 35(12), 1715–1725. https://doi.org/10.1681/ASN.0000000000000468
Sah, S. K., Chaudhary, R. P., & Silwal, S. (2022). Posterior Urethral Valves; Outcome Analysis after Endoscopic Valve Ablation. Annapurna Journal of Health Sciences, 2(1), 40–45.
Şahan, A., Akbal, C., Garayev, A., Şekerci, Ç. A., Sulukaya, M., Tanıdır, Y., Tinay, İ., Tarcan, T., & Şimşek, F. (2015). Can Surgical Technique Affect the Success of Endoscopic Treatment in Children with Vesicoureteral Reflux and Overactive Bladder Syndrome? Journal of Urological Surgery, 2(3), 135–140. https://doi.org/10.4274/jus.367
Sarier, M., Duman, I., Demir, M., Yuksel, Y., Emek, M., & Kukul, E. (2018). The outcomes of transurethral incision/resection of the prostate (TUIP/TURP) performed early after renal transplantation. Türk Üroloji Dergisi/Turkish Journal of Urology, 44(2), 172–177. https://doi.org/10.5152/tud.2018.98404
Scheidt, M. J., Hohenwalter, E. J., Pinchot, J. W., Ahmed, O., Bjurlin, M. A., Braun, A. R., Kim, C. Y., Knavel Koepsel, E. M., Schramm, K., Sella, D. M., Weiss, C. R., & Lorenz, J. M. (2020). ACR Appropriateness Criteria® Radiologic Management of Urinary Tract Obstruction. Journal of the American College of Radiology, 17(5), S281–S292. https://doi.org/10.1016/j.jacr.2020.01.039
Sharifiaghdas, F., & Saberi, N. (2023). Mechanical Ablation of the Posterior Urethral Valve Omitting Thermal Energy: A Brief Report. Iranian Journal of Medical Sciences, 48(5). https://doi.org/10.30476/ijms.2022.95313.2660
Sharma, S. (2020). Posterior urethral valves consensus. Journal of Indian Association of Pediatric Surgeons, 25(4), 261. https://doi.org/10.4103/jiaps.JIAPS_157_19
Shitsuka et al. (2014). Matemática fundamental para a tecnologia. Editora Érica.
Sidibe, Dr. S., Kalba, T., A, D., K, D. W., A, S., S, K. Z., M, C. T. H., A, S., Y, D., O, T., & Y, C. (2023). Posterior Urethral Valves in the Pediatric Surgery Unit of the Mali Hospital. SAS Journal of Surgery, 9(04), 305–308. https://doi.org/10.36347/sasjs.2023.v09i04.016
Simsek, C., Dogan, S. M., Piskin, T., Okut, G., Cayhan, K., Aykas, A., Tatar, E., & Uslu, A. (2017). Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study. Transplantation Proceedings, 49(3), 517–522. https://doi.org/10.1016/j.transproceed.2017.01.018
Snow, B. W., Wallis, M. C., Feola, G. P., Rampton, J. W., & Shiozaki, T. (2014). Interventional Radiology Procedures after Pediatric Pyeloplasty and Ureteral Reimplantation in Patients with Postoperative Obstruction. Open Journal of Urology, 4(6), 87–90. https://doi.org/10.4236/oju.2014.46015
Sowande, O., Salako, A., Adewale, O., Adesoji, A., Olusegun, T., & Mopelola, A. (2015). Foley catheter avulsion of posterior urethral valves: An alternative in resource poor setting. Archives of International Surgery, 5(1), 7. https://doi.org/10.4103/2278-9596.153141
Stein, R., Hohenfellner, M., Pahernik, S., Roth, S., Thüroff, J. W., & Rübben, H. (2012). Urinary Diversion. Deutsches Ärzteblatt international. https://doi.org/10.3238/arztebl.2012.0617
T., J., & Vadivelu, G. (2020). A study proposal on short term outcome and prognosis of primary and delayed fulguration in posterior urethral valve. International Surgery Journal, 7(10), 3389. https://doi.org/10.18203/2349-2902.isj20203999
Tambo, F. F. M., Tolefac, P. N., Ngowe, M. N., Minkande, J. Z., Mbouche, L., Guemkam, G., Telelen, N. A., Angwafo, F. F., & Sosso, A. M. (2018). Posterior urethral valves: 10 years audit of epidemiologic, diagnostic and therapeutic aspects in Yaoundé gynaeco-obstetric and paediatric hospital. BMC Urology, 18(1), 46. https://doi.org/10.1186/s12894-018-0364-1
Vieira, S. (2021). Introdução à bioestatística. Editora GEN/Guanabara Koogan.
Vroomen, L. G. P. H., John, N. T., Fuijmori, M., Sivaraman, A., Felsen, D., & Srimathveeravalli, G. (2020). A new intrasurgical technique to safely and reproducibly induce partial unilateral urinary obstruction and renal scarring in a Rat Model. International Urology and Nephrology, 52(7), 1209–1218. https://doi.org/10.1007/s11255-020-02421-1
Weise, L., Chiapaikeo, D., Tan, T.-W., Weinkauf, C., Goshima, K. R., & Zhou, W. (2022). Role of late renal revascularization in functional renal salvage. Journal of Vascular Surgery Cases, Innovations and Techniques, 8(1), 121–124. https://doi.org/10.1016/j.jvscit.2021.09.009
Wu, C. Q., Lovin, J. M., Patil, D., & Smith, E. A. (2022). Role of progressive urethral dilation and primary valve ablation in the long-term renal outcomes of small, preterm infants with posterior urethral valve. Journal of Pediatric Urology, 18(6), 802.e1-802.e6. https://doi.org/10.1016/j.jpurol.2022.06.007
Wu, C. Q., Ntaganda, E., Hittelman, A. B., Wolke, S., & Amah, C. C. (2020). Posterior Urethral Valves. Em E. A. Ameh, S. W. Bickler, K. Lakhoo, B. C. Nwomeh, & D. Poenaru (Orgs.), Pediatric Surgery (p. 965–971). Springer International Publishing. https://doi.org/10.1007/978-3-030-41724-6_93
Zuling, E., Mashinchi, J., Radford, A., & Subramaniam, R. (2022). 274 Retrospective Cohort Study of the Long-Term Outcome of Posterior Urethral Valve – A Single Centre Experience. British Journal of Surgery, 109(Supplement_6), znac269.291. https://doi.org/10.1093/bjs/znac269.291
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