Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada.
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
World J Urol. 2022 Sep;40(9):2181-2194. doi: 10.1007/s00345-022-04097-x. Epub 2022 Aug 9.
To determine through a comprehensive systematic review and meta-analysis the differences in the outcomes of prenatally versus postnatally diagnosed posterior urethral valves (PUV) to ascertain if prenatal detection of PUV has superior outcomes.
We conducted a systematic review and meta-analysis in March 2022 (PROSPERO ID - CRD42021243546) and included all studies that reported outcomes of prenatally and postnatally diagnosed PUV. However, for meta-analysis, only those studies that described both groups were included. The main outcomes of interest included progression of chronic kidney disease (CKD), need for renal replacement therapy (RRT) and renal transplant, and bladder dysfunction as determined by initiation of clean intermittent catheterization (CIC). Time to event analyses were completed when possible.
The systematic review included 49 studies (3820 patients). The pooled effect estimates for progression to CKD (OR 0.75 [95% CI 0.43, 1.31]), need for RRT (OR 1.39 [95% CI 0.64, 2.99]) and need for renal transplant (OR 1.64 [95% CI 0.61, 4.42]) between prenatal and postnatal groups was not different. CICs rates were as high as 32% in the prenatal group and 22% in the postnatal group. Most studies had a moderate or serious risk of bias.
The existing comparative literature on prenatal versus postnatal presentation of PUV is very heterogeneous. The diagnostic and treatment protocols have not been reported in majority of the studies. The outcome variables are also reported inconsistently. Based on the current evidence, prenatal diagnosis of PUV does not appear to improve the long-term outcomes of these patients.
通过全面的系统评价和荟萃分析，确定产前和产后诊断的后尿道瓣膜（PUV）的结局差异，以确定产前检测 PUV 是否具有更好的结局。
我们于 2022 年 3 月进行了系统评价和荟萃分析（PROSPERO ID - CRD42021243546），并纳入了所有报告产前和产后诊断的 PUV 结局的研究。然而，为了进行荟萃分析，仅纳入了描述这两个组的研究。主要观察结局包括慢性肾脏病（CKD）的进展、需要肾脏替代治疗（RRT）和肾移植，以及膀胱功能障碍（通过开始间歇性清洁导尿术[CIC]来确定）。在可能的情况下，完成了时间事件分析。
系统评价纳入了 49 项研究（3820 例患者）。产前和产后组之间进展为 CKD（OR 0.75 [95% CI 0.43, 1.31]）、需要 RRT（OR 1.39 [95% CI 0.64, 2.99]）和需要肾移植（OR 1.64 [95% CI 0.61, 4.42]）的累积效应估计值没有差异。产前组的 CIC 率高达 32%，而产后组为 22%。大多数研究存在中度或严重的偏倚风险。
关于 PUV 产前和产后表现的现有比较文献非常多样化。大多数研究未报告诊断和治疗方案，也未一致报告结局变量。根据现有证据，产前诊断 PUV 似乎并不能改善这些患者的长期结局。
