Hydrodistention implantation technique as a more effective endoscopic approach for primary vesicoureteral reflux: a meta-analysis

Abstract

Objective To evaluate the curative rate of hydrodistention implantation technique (HIT) versus subureteral transurethral injection (STING) for primary vesicoureteral reflux (PVUR) so as to provide its clinical therapeutic rationales. Methods From January 2004 Wanfang Datebase, China National Knowledge Internet, PubMed, Elsevier, EBSCO and Web of Science were searched with regards to evaluating the curative rate of HIT vs STING for PVUR. The qualities of selected studies were evaluated and Meta-analysis conducted with RevMan 5.3 software. Results A total of 482 foreign literatures were retrieved. And 4 English reports were selected. The results of meta-analysis indicated that the single-injection curative rate of HIT group was higher than that of STING group (RR=1.15, 95%CI: 1.07-1.25, Z=3.61, P=0.000 3). However, no significant difference existed in overall curative rate after three injections between two groups (RR=1.14, 95%CI: 0.99-1.31, Z=1.80, P=0.07). For grades I & II PVUR, no inter-group statistical difference existed in single-injection curative rate (RR=1.05, 95%CI: 0.95-1.16, Z=0.94, P=0.35). For grade III PVUR, the single-injection curative rate of HIT group was higher than that of STING group (RR=1.20, 95%CI: 1.00-1.43, Z=1.97, P<0.05). For grade IV PVUR, no significant inter-group difference existed in single-injection curative rate (RR=1.30, 95%CI: 0.95-1.78, Z=1.65, P=0.10) and overall curative rate after three injections (RR=1.24, 95%CI: 0.94-1.63, Z=1.54, P=0.12). Conclusions HIT group was higher than STING group in single-injection curative rate of PVUR. Both HIT and STING are efficacious for grades I and II PVUR while HIT is more ideal for grade III PVUR. Key words: Primary vesicoureteral reflux; Urogenital surgical procedures; Cure rate; Comparative study