Gholami Bahareh, Gholami Samira, Khodaei Behzad, Sharifiaghdas Farzaneh
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, NO.103, 9th Boostan Street, Pasdaran Avenue, Tehran, Iran.
Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Labbafinejad Medical Center, NO.103, 9th Boostan Street, Pasdaran Avenue, Tehran, Iran.
J Pediatr Urol. 2022 Oct;18(5):664-673. doi: 10.1016/j.jpurol.2022.08.012. Epub 2022 Aug 20.
Our study aimed to compare the efficacy of polyacrylate polyalcohol copolymer and Dextranomer-Hyaluronic Acid for endoscopic treatment of vesicoureteral reflux.
MEDLINE, EMBASE, Scopus, Web of science, Ovid, Cochrane databases, Google scholar have been searched for studies published until January 2022 in any language. Studies that compared the success rate for endoscopic treatment of vesicoureteral reflux in children with two bulking agents, namely, "polyacrylate polyalcohol copolymer." and "Dextranomer-Hyaluronic Acid" were included for this analysis.
Nine studies were included in data synthesis for this meta-analysis. Pooled data with a total of 763 ureters in PPC group and 718 ureters in Dx/HA group indicated that ureters in PPC group were more likely to undergo complete reflux resolution than Dx/HA (OR 3.80, 95% CI: 2.71; 5.31). Among subgroup of patients with high grade reflux, PPC injection had more resolution rate compared to Dx/HA patients (OR: 2.92, 95% CI: 1.19-7.16). In total, 95.81% of the PPC group and 86.52% of the Dx/HA group experienced success after the third injection. However a concerning complication of endoscopic treatment which is ureterovesical junction obstruction (UVJO) was more prevalent in PPC group. So the possible benefits arising from endoscopic treatment with PPC could be offset by the costs of re-implantation surgery or stenting in the case of UVJO.
These data indicate that PPC injection for vesicoureteral reflux treatment was associated with a higher success rate, but concerningly, UVJO incidence was higher in the PPC group which might negate the possible benefits of PPC injection However, due to the lack of studies with long-term follow-up, we couldn't reach a definitive conclusion about the superiority of one of the bulking agents over the other.
本研究旨在比较聚丙烯酸多元醇共聚物和葡聚糖-透明质酸在内镜治疗膀胱输尿管反流中的疗效。
检索了MEDLINE、EMBASE、Scopus、Web of science、Ovid、Cochrane数据库以及谷歌学术，查找截至2022年1月以任何语言发表的研究。纳入比较两种填充剂（即“聚丙烯酸多元醇共聚物”和“葡聚糖-透明质酸”）用于儿童膀胱输尿管反流内镜治疗成功率的研究进行分析。
本荟萃分析的数据合成纳入了9项研究。PPC组共有763条输尿管，Dx/HA组共有718条输尿管，汇总数据表明，PPC组的输尿管比Dx/HA组更有可能实现完全反流消退（OR 3.80，95% CI：2.71；5.31）。在重度反流患者亚组中，与Dx/HA患者相比，PPC注射的消退率更高（OR：2.92，95% CI：1.19 - 7.16）。总体而言，PPC组95.81%和Dx/HA组86.52%在第三次注射后取得成功。然而，内镜治疗的一个令人担忧的并发症即输尿管膀胱连接部梗阻（UVJO）在PPC组中更为普遍。因此，在出现UVJO的情况下，PPC内镜治疗可能带来的益处可能会被再次植入手术或置入支架的费用所抵消。
这些数据表明，PPC注射治疗膀胱输尿管反流的成功率较高，但令人担忧的是，PPC组的UVJO发生率较高，这可能会抵消PPC注射可能带来的益处。然而，由于缺乏长期随访研究，我们无法就一种填充剂相对于另一种填充剂的优越性得出明确结论。
