Dextranomer/Hyaluronic Acid for Pediatric Vesicoureteral Reflux: Systematic Review

• Published in: Pediatrics (Evanston) 2010-05, Vol.125 (5), p.1010-1019
• Main Authors: ROUTH, Jonathan C, INMAN, Brant A, REINBERG, Yuri
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Bladder exstrophy; Care and treatment; Chemical compounds; Child; Children & youth; Clinical outcomes; Congenital bladder anomalies; Controlled Clinical Trials as Topic; Dextrans; Dosage and administration; Female; General aspects; Humans; Hyaluronic Acid; Injections; Male; Medical sciences; Medical treatment; Miscellaneous; Nephrology. Urinary tract diseases; Pediatrics; Postoperative Complications - physiopathology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Systematic review; Treatment Outcome; Ureter; Ureteroscopy; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Urodynamics - physiology; Vesico-Ureteral Reflux - classification; Vesico-Ureteral Reflux - diagnosis; Vesico-Ureteral Reflux - surgery
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2009-2225

Published success rates of dextranomer/hyaluronic acid (Dx/HA) injection for pediatric vesicoureteral reflux (VUR) vary widely. Our objective of this study was to assess whether underlying patient or study factors could explain the heterogeneity in reported Dx/HA success rates. We searched the Cochrane Controlled Trials Register and Medline, Embase, and Scopus databases from 1990 to 2008 for reports in any language, along with a hand search of included study bibliographies. Articles were assessed and data abstracted in duplicate, and differences were resolved by consensus. Conflict of interest (COI) was determined by published disclosure. Meta-regression was performed to adjust for patient as well as study-level factors. We identified 1157 reports, 89 of which were reviewed in full with 47 included in the pooled analysis. Of 7303 ureters that were injected with Dx/HA, 5633 (77%) were successfully treated according to the authors' definition. Injection success seemed to vary primarily on the basis of the preoperative reflux grade. After adjustment for VUR grade, other factors, such as the presence or absence of COI disclosure, were not significant. Studies were markedly heterogeneous overall. The overall per-ureter Dx/HA success rate was 77% after 3 months, although success rates varied widely among studies. Increased VUR grade negatively affected success rates, whereas COI, patient age, and injected Dx/HA volume were not significantly associated with treatment outcome after adjustment for VUR grade. There is a significant need for improved reporting of VUR treatments, including comparative studies of Dx/HA and other VUR treatments.