Approach to the management of ureterocele and clinical outcomes in the pediatric population: a systematic review

Approach to the management of ureterocele and clinical outcomes in the pediatric population: a systematic review

Ana Ma. Ortiz-Zableh 1 , Andrés F. Quiñones-Roa 2 , Ana I. López 3 , Camila Pérez-Medina 4 , Eliana Calderón-Rivera 4 , Víctor H. Figueroa-Arenas 5 , Paul A. Camacho 6

1 Servicio de Urología, Centro Urológico FOSCAL, Colombia; 2 Departamento de Urología, Clínica Foscal, Universidad Autónoma de Bucaramanga (UNAB), Bucaramanga, Colombia; 3 Departamento de Urología, Universidad Fundación Universitaria de Ciencias de la Salud (FUCS), Bogotá, Colombia; 4 Facultad de Medicina, Universidad de Pamplona, Pamplona, Norte de Santander, Colombia; 5 Departamento de Urología, Clínica FOSCAL, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia; 6 Centro de Investigaciones FOSCAL-FOSCAL Internacional, Universidad Autónoma de Bucaramanga. Bucaramanga, Santander, Colombia

*Correspondence: Ana Ma. Ortiz-Zableh. Email: aortiz779@unab.edu.co

Abstract

There is controversy and little literature on the management guidelines for ureterocele and its outcomes since the approach varies from endoscopic procedures to complete reconstruction. Our objective is to evaluate the effectiveness and safety of the different therapeutic approaches for ureterocele and their clinical outcomes in the pediatric population. Systematic review of the literature, answering the question: What are the different management options for ureterocele and its clinical outcomes in the pediatric population? Two hundred and twenty articles were found, we selected 48 articles, for a total of 2,082 patients.We evaluated the methodological quality with the ROBINS-I tool.A meta-analysis of postoperative reflux improvement was performed. Patients with postoperative VUR showed improvement after treatment with an odds ratio 0.24; a great heterogeneity was evidenced among the studies (I2: 85%; p < 0.001].The association between the treatments performed and the presence of pre-VUR did not show a statistically significant difference (p = 0.321), in contrast to post-VUR (p = 0.02). Regarding the presence of pre- and post-UTI, no related statistically significant difference was found (p = 0.428 and p = 0.825). There is a significant variation in the approach, initial management, and follow-up of patients with ureterocele, possibly secondary to the mode of presentation and clinical course. In addition, the improvement in VUR after surgical treatment of the ureterocele is significant. The importance of conducting multi-institutional, prospective, randomized, and controlled studies is key to evaluating the treatment and long-term results of this pathology.

Keywords: Ureterocele; Pediatrics; Urology; Ureteral diseases; Surgery; Endoscopic surgery

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