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Meta-Analysis
. 2023 Nov;38(11):3549-3558.
doi: 10.1007/s00467-023-05938-6. Epub 2023 Mar 30.

Non-surgical management in children with non-refluxing primary megaureter: a systematic review and meta-analysis

Kathrin Buder  1 , Kathrin Opherk  2 , Sara Mazzi  3 , Katharina Rohner  3 , Marcus Weitz  2
Affiliations
Meta-Analysis

Non-surgical management in children with non-refluxing primary megaureter: a systematic review and meta-analysis

Kathrin Buder et al. Pediatr Nephrol. 2023 Nov.

Abstract

Background: Children with non-refluxing primary megaureter are mostly managed by a watchful approach with close follow-up and serial imaging.

Objectives: This systematic review and meta-analysis aimed to determine whether there is sufficient evidence to support the current non-surgical management strategy in these patients.

Data sources: A comprehensive search including electronic literature databases, clinical trial registries, and conference proceedings was performed.

Data synthesis methods: Outcomes were estimated as pooled prevalence. If meta-analytical calculations were not appropriate, outcomes were provided in a descriptive manner.

Results: Data from 8 studies (290 patients/354 renal units) were included. For the primary outcome, differential renal function estimated by functional imaging, meta-analysis was impossible due to reported data not being precise. Pooled prevalence for secondary surgery was 13% (95% confidence interval: 8-19%) and for resolution 61% (95% confidence interval: 42-78%). The risk of bias was moderate or high in most studies.

Limitations: This analysis was limited by the low number of eligible studies with few participants and high clinical heterogeneity, and the poor quality of the available data.

Conclusions: The low pooled prevalence of secondary surgical intervention and high pooled prevalence of resolution may support the current non-surgical management in children with non-refluxing primary megaureter. However, these results should be interpreted cautiously due to the limited available body of evidence. Future studies should overcome existing limitations of imaging methods by using standardized, comparable criteria and report outcome parameters in a quantitative manner. This would allow more sufficient data synthesis to provide evidence-based recommendations for clinical decision-making and counseling.

Systematic review registration: The protocol was registered on PROSPERO under CRD42019134502.

Keywords: Differential renal function; Non-surgical management; Pelvicalyceal dilatation; Primary megaureter; Uretero-vesical junction obstruction.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow diagram according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [12]
Fig. 2
Fig. 2
Risk of bias summary: review authors’ judgements on each risk of bias category presented as percentages across all studies included
Fig. 3
Fig. 3
Risk of bias: review authors’ judgements on each risk of bias category for each study included
Fig. 4
Fig. 4
Pooled prevalence of resolution in non-refluxing primary megaureter
Fig. 5
Fig. 5
Pooled prevalence of secondary surgery in non-refluxing primary megaureter
Fig. 6
Fig. 6
Reasons for secondary surgery in non-refluxing primary megaureter
See this image and copyright information in PMC

References

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