Comparison of polyacrylate polyalcohol copolymer (PPC) and dextranomer/hyaluronic acid (Dx/HA) for treatment of vesicoureteral reflux. A systematic review and meta-analysis. Issue 5 (October 2022)

• Record Type: Journal Article
• Authors: Gholami, Bahareh; Gholami, Samira; Khodaei, Behzad; Sharifiaghdas, Farzaneh
• Is Part Of: Journal of pediatric urology. Volume 18:Issue 5(2022)
• Page Start: 664
• Page End: 673
• Publication Date: 2022-10
• Subjects: Vesico ureteral reflux -- Polyacrylate polyalcohol copolymer -- Dextranomer-hyaluronic acid copolymer; Dx/HA = dextranomer/hyaluronic acid PPC = polyacrylate polyalcohol copolymer -- VUR = vesico ureteral reflux UO = ureteral obstruction -- ET = endoscopic treatment UTI = urinary tract infection -- VCUG = voiding cystourethrogram UVJO = ureterovesical junction obstruction -- RCS = retrospective cohort study PCS = prospective cohort study -- RCT = randomized control trial HIT = hydrodistension implantation technique -- STING = subureteral transurethral injection RRU = renal refluxing units; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2022.08.012
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: Purpose: Our study aimed to compare the efficacy of polyacrylate polyalcohol copolymer and Dextranomer-Hyaluronic Acid for endoscopic treatment of vesicoureteral reflux. Material and methods: MEDLINE, EMBASE, Scopus, Web of science, Ovid, Cochrane databases, Google scholar have been searched for studies published until January 2022 in any language. Studies that compared the success rate for endoscopic treatment of vesicoureteral reflux in children with two bulking agents, namely, "polyacrylate polyalcohol copolymer." and "Dextranomer-Hyaluronic Acid" were included for this analysis. Results: Nine studies were included in data synthesis for this meta-analysis. Pooled data with a total of 763 ureters in PPC group and 718 ureters in Dx/HA group indicated that ureters in PPC group were more likely to undergo complete reflux resolution than Dx/HA (OR 3.80, 95% CI: 2.71; 5.31). Among subgroup of patients with high grade reflux, PPC injection had more resolution rate compared to Dx/HA patients (OR: 2.92, 95% CI: 1.19–7.16). In total, 95.81% of the PPC group and 86.52% of the Dx/HA group experienced success after the third injection. However a concerning complication of endoscopic treatment which is ureterovesical junction obstruction (UVJO) was more prevalent in PPC group. So the possible benefits arising from endoscopic treatment with PPC could be offset by the costs of re-implantation surgery or stenting in the case of UVJO. Conclusion: These data indicate that PPC injection for vesicoureteral reflux treatment was associated with a higher success rate, but concerningly, UVJO incidence was higher in the PPC group which might negate the possible benefits of PPC injection However, due to the lack of studies with long-term follow-up, we couldn't reach a definitive conclusion about the superiority of one of the bulking agents over the other.