Jin Kyu Kim, Nikhil Batra, Pete Arnold, Renee Shavnore, Konrad M Szymanski, Martin Kaefer, Joshua Roth, Benjamin Whittam, Pankaj Dangle, Kirstan Meldrum, Richard Rink, Mark Cain, Rosalia Misseri
{"title":"评估输尿管囊肿患儿排尿功能障碍的风险:一项系统回顾和荟萃分析。","authors":"Jin Kyu Kim, Nikhil Batra, Pete Arnold, Renee Shavnore, Konrad M Szymanski, Martin Kaefer, Joshua Roth, Benjamin Whittam, Pankaj Dangle, Kirstan Meldrum, Richard Rink, Mark Cain, Rosalia Misseri","doi":"10.1016/j.jpurol.2025.07.006","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Ureterocele is a congenital anomaly potentially associated with voiding dysfunction (VD), often requiring surgical intervention. While surgery aims to relieve obstruction and preserve renal function, postoperative VD and related complications remain significant concerns.</p><p><strong>Objectives: </strong>This systematic review aims to evaluate the prevalence of VD and associated outcomes in children following ureterocele surgery.</p><p><strong>Study design: </strong>A systematic search of Medline, Embase, and Web of Science identified studies reporting VD (lower urinary tract dysfunction/symptoms) or related outcomes in children undergoing ureterocele interventions. Random effects meta-analysis was performed to calculate pooled prevalence rates for VD, incontinence, elevated post-void residuals (PVR), and recurrent UTIs. Heterogeneity was assessed using I<sup>2</sup> statistics, and publication bias was evaluated with funnel plots and trim-and-fill analyses.</p><p><strong>Results: </strong>Fourteen retrospective studies including 1266 patients were analyzed. VD was reported in 25 % of patients (95 % CI 15-36 %), with significant heterogeneity (I<sup>2</sup> = 91.2 %). Incontinence occurred in 11 % (95 % CI 6-18 %), and elevated PVR were present in 20 % (95 % CI 7-38 %). Recurrent UTIs occurred in 22 %, but febrile UTIs were lower at 9 % (95 % CI 5-14 %), with minimal heterogeneity (I<sup>2</sup> = 0 %). Heterogeneity and bias were notable, likely due to varied definitions, surgical techniques, and follow-up durations across studies. Risk of bias was high, especially in domain 1 (bias due to confounding) with high likelihood of publication bias with trim-and-fill analysis suggesting lower rates of VD (8.5 %, 95 % CI 2.5-17.1 %) DISCUSSION: This study has key limitations, including biases from retrospective data, reliance on aggregate outcomes, heterogeneity in definitions and methods, and possible reporting biases. As children in this systematic review have undergone interventions, it is difficult to ascertain whether VD is attributable to congenital patient factors or more influenced by surgical technique. Despite this, the review provides a highest level of summary of voiding dysfunction prevalence in children with ureterocele.</p><p><strong>Conclusion: </strong>Within limitation of current evidence, there is notable prevalence of postoperative voiding dysfunction and incontinence in children undergoing ureterocele surgery. The findings emphasize the need for standardized definitions and prospective studies to better characterize long-term outcomes and improve clinical decision-making for this population.</p>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing the risk of voiding dysfunction in children with ureteroceles: A systematic review and meta-analysis.\",\"authors\":\"Jin Kyu Kim, Nikhil Batra, Pete Arnold, Renee Shavnore, Konrad M Szymanski, Martin Kaefer, Joshua Roth, Benjamin Whittam, Pankaj Dangle, Kirstan Meldrum, Richard Rink, Mark Cain, Rosalia Misseri\",\"doi\":\"10.1016/j.jpurol.2025.07.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Ureterocele is a congenital anomaly potentially associated with voiding dysfunction (VD), often requiring surgical intervention. While surgery aims to relieve obstruction and preserve renal function, postoperative VD and related complications remain significant concerns.</p><p><strong>Objectives: </strong>This systematic review aims to evaluate the prevalence of VD and associated outcomes in children following ureterocele surgery.</p><p><strong>Study design: </strong>A systematic search of Medline, Embase, and Web of Science identified studies reporting VD (lower urinary tract dysfunction/symptoms) or related outcomes in children undergoing ureterocele interventions. Random effects meta-analysis was performed to calculate pooled prevalence rates for VD, incontinence, elevated post-void residuals (PVR), and recurrent UTIs. Heterogeneity was assessed using I<sup>2</sup> statistics, and publication bias was evaluated with funnel plots and trim-and-fill analyses.</p><p><strong>Results: </strong>Fourteen retrospective studies including 1266 patients were analyzed. VD was reported in 25 % of patients (95 % CI 15-36 %), with significant heterogeneity (I<sup>2</sup> = 91.2 %). Incontinence occurred in 11 % (95 % CI 6-18 %), and elevated PVR were present in 20 % (95 % CI 7-38 %). Recurrent UTIs occurred in 22 %, but febrile UTIs were lower at 9 % (95 % CI 5-14 %), with minimal heterogeneity (I<sup>2</sup> = 0 %). Heterogeneity and bias were notable, likely due to varied definitions, surgical techniques, and follow-up durations across studies. Risk of bias was high, especially in domain 1 (bias due to confounding) with high likelihood of publication bias with trim-and-fill analysis suggesting lower rates of VD (8.5 %, 95 % CI 2.5-17.1 %) DISCUSSION: This study has key limitations, including biases from retrospective data, reliance on aggregate outcomes, heterogeneity in definitions and methods, and possible reporting biases. As children in this systematic review have undergone interventions, it is difficult to ascertain whether VD is attributable to congenital patient factors or more influenced by surgical technique. Despite this, the review provides a highest level of summary of voiding dysfunction prevalence in children with ureterocele.</p><p><strong>Conclusion: </strong>Within limitation of current evidence, there is notable prevalence of postoperative voiding dysfunction and incontinence in children undergoing ureterocele surgery. The findings emphasize the need for standardized definitions and prospective studies to better characterize long-term outcomes and improve clinical decision-making for this population.</p>\",\"PeriodicalId\":16747,\"journal\":{\"name\":\"Journal of Pediatric Urology\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-07-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Pediatric Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jpurol.2025.07.006\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpurol.2025.07.006","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
导言:输尿管囊肿是一种先天性异常,可能与排尿功能障碍(VD)有关,通常需要手术干预。虽然手术的目的是减轻梗阻和保持肾功能,但术后VD和相关并发症仍然是值得关注的问题。目的:本系统综述旨在评估输尿管囊肿手术后儿童VD患病率及相关结局。研究设计:对Medline、Embase和Web of Science进行系统检索,确定了在接受输尿管膨出干预的儿童中报告VD(下尿路功能障碍/症状)或相关结果的研究。随机效应荟萃分析计算VD、尿失禁、尿后残留物升高(PVR)和复发性尿路感染的总患病率。异质性评估采用I2统计量,发表偏倚评估采用漏斗图和修剪填充分析。结果:回顾性分析了14项研究,包括1266例患者。25%的患者报告了VD (95% CI 15- 36%),具有显著的异质性(I2 = 91.2%)。尿失禁发生率为11% (95% CI为6- 18%),PVR升高发生率为20% (95% CI为7- 38%)。复发性尿路感染发生率为22%,但发热性尿路感染发生率较低,为9% (95% CI 5- 14%),异质性最小(I2 = 0%)。异质性和偏倚是显著的,可能是由于不同研究的定义、手术技术和随访时间不同。偏倚风险高,特别是在域1(由于混杂引起的偏倚),发表偏倚的可能性高,trim- fill分析表明VD发生率较低(8.5%,95% CI 2.5- 17.1%)。讨论:本研究存在主要局限性,包括来自回顾性数据的偏倚,对总体结果的依赖,定义和方法的异质性,以及可能的报告偏倚。由于本系统综述中的儿童接受过干预,因此很难确定VD是由先天性患者因素引起的,还是更多地受手术技术的影响。尽管如此,该综述提供了输尿管囊肿儿童排尿功能障碍患病率的最高水平总结。结论:在目前证据有限的情况下,输尿管膨出手术的儿童存在明显的术后排尿功能障碍和尿失禁。研究结果强调了标准化定义和前瞻性研究的必要性,以更好地描述长期结果并改善该人群的临床决策。
Assessing the risk of voiding dysfunction in children with ureteroceles: A systematic review and meta-analysis.
Introduction: Ureterocele is a congenital anomaly potentially associated with voiding dysfunction (VD), often requiring surgical intervention. While surgery aims to relieve obstruction and preserve renal function, postoperative VD and related complications remain significant concerns.
Objectives: This systematic review aims to evaluate the prevalence of VD and associated outcomes in children following ureterocele surgery.
Study design: A systematic search of Medline, Embase, and Web of Science identified studies reporting VD (lower urinary tract dysfunction/symptoms) or related outcomes in children undergoing ureterocele interventions. Random effects meta-analysis was performed to calculate pooled prevalence rates for VD, incontinence, elevated post-void residuals (PVR), and recurrent UTIs. Heterogeneity was assessed using I2 statistics, and publication bias was evaluated with funnel plots and trim-and-fill analyses.
Results: Fourteen retrospective studies including 1266 patients were analyzed. VD was reported in 25 % of patients (95 % CI 15-36 %), with significant heterogeneity (I2 = 91.2 %). Incontinence occurred in 11 % (95 % CI 6-18 %), and elevated PVR were present in 20 % (95 % CI 7-38 %). Recurrent UTIs occurred in 22 %, but febrile UTIs were lower at 9 % (95 % CI 5-14 %), with minimal heterogeneity (I2 = 0 %). Heterogeneity and bias were notable, likely due to varied definitions, surgical techniques, and follow-up durations across studies. Risk of bias was high, especially in domain 1 (bias due to confounding) with high likelihood of publication bias with trim-and-fill analysis suggesting lower rates of VD (8.5 %, 95 % CI 2.5-17.1 %) DISCUSSION: This study has key limitations, including biases from retrospective data, reliance on aggregate outcomes, heterogeneity in definitions and methods, and possible reporting biases. As children in this systematic review have undergone interventions, it is difficult to ascertain whether VD is attributable to congenital patient factors or more influenced by surgical technique. Despite this, the review provides a highest level of summary of voiding dysfunction prevalence in children with ureterocele.
Conclusion: Within limitation of current evidence, there is notable prevalence of postoperative voiding dysfunction and incontinence in children undergoing ureterocele surgery. The findings emphasize the need for standardized definitions and prospective studies to better characterize long-term outcomes and improve clinical decision-making for this population.
期刊介绍:
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.