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Yadav P, Rickard M, Kim JK, Richter J, Lolas M, Alshammari D, Chua ME, Dos Santos J, Lorenzo AJ. Comparison of outcomes of prenatal versus postnatal presentation of posterior urethral valves: a systematic review and meta-analysis. World J Urol 2022; 40:2181-2194. [PMID: 35943527 DOI: 10.1007/s00345-022-04097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Priyank Yadav
- 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
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Juliane Richter
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Marisol Lolas
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Dheidan Alshammari
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
- Institute of Urology, St. Luke's Medical Center, Quezon, Philippines
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), University of Toronto, Toronto, ON, M5G 1X8, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Kalra S, Biswas A, Bose T, Mandal R, Kapoor T. A snapshot of children with congenital anomalies of the kidneys and urinary tract at three tertiary care centers of the armed forces. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_74_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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