Comparative Analysis of Ureteral Reimplantation and Dextranomer/Hyaluronic Acid Injection Between Two Centers with Systematic Review and Meta-Analysis.
meta_analysis · Level I
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- Also identified by DOI 10.1097/JU.0000000000005138.
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Abstract
Surgical management of pediatric vesicoureteral reflux (VUR) aims to reduce febrile urinary tract infections (fUTIs) while minimizing perioperative morbidity. We compared dextranomer/hyaluronic acid (Dx/HA) injection with ureteral reimplantation, focusing on durability, infectious outcomes, and perioperative burden. We conducted an era-matched and indication-matched retrospective two-center cohort study (January 2018-December 2025) of children < 18 years treated for recurrent UTIs with Dx/HA or reimplantation, alongside a PRISMA-guided systematic review and meta-analysis (MEDLINE, Embase, Scopus; inception to December 2025; PROSPERO CRD420251154210). Outcomes included radiographic resolution, reoperation, postoperative fUTIs, operative time, and length of stay (LOS). Random-effects models were used; heterogeneity was assessed with tau<sup>2</sup> and bias with RoB 2.0/ROBINS-I. Institutional cohorts included 179 Dx/HA and 130 reimplantations. Dx/HA had shorter operative time (21 vs 140 minutes; <i>P</i> < .001) and LOS (0 vs 1 day; <i>P</i> < .001). Thirty-day ED visits, readmissions, non-UTI complications, and redo surgery did not differ (all <i>P</i> > .2). Postoperative UTI (19.6% vs 3.8%; <i>P</i> < .001) and recurrent UTI (11.7% vs 1.5%; <i>P</i> < .001) were higher after Dx/HA; procedure type independently predicted UTI (HR 5.6, 95% CI 2.1-14.6; <i>P</i> < .001). Meta-analysis (15 studies) favored reimplantation for radiographic resolution (RR for nonresolution 4.30; <i>P</i> = .0003; tau<sup>2</sup> = 0.44) and reoperation (RR 6.42; <i>P</i> < .00001; tau<sup>2</sup> = 0.20), while febrile/recurrent UTI did not differ (tau<sup>2</sup> = 1.12). Evidence certainty was limited by heterogeneity and predominantly nonrandomized data. Ureteral reimplantation has lower likelihood of reoperation and with possibly postoperative UTI risk, while Dx/HA offers meaningful perioperative advantages. These trade-offs support individualized, risk-adapted surgical decision-making for pediatric VUR.