MP-23 Meta-analysis to study the outcomes of early versus expectant management of pediatric neurogenic bladder
01/01/70 from 21:45 to 22:15
TBD
Presenter

Yilong Li, Canada

Research student

Western University

Abstract

Meta-analysis to study the outcomes of early versus expectant management of pediatric neurogenic bladder

Yilong Li1, Noah Stern2, Zhan Tao (Peter) Wang2, Sumit Dave2.

1Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; 2Division of Urology, Western University, London, ON, Canada

The study was funded by the Western Undergraduate Summer Research Grant for Yilong Li.

Introduction: The indications and outcomes of proactive management of pediatric neurogenic bladder (NB) patients have been unclear. This systematic review and meta-analysis (MA) conducted using PRISMA guidelines, reviews the effects of early versus expectant management of pediatric NB patients. 

Methods: We performed a literature search on EMBASE and MEDLINE (January 1, 2000 to January 1, 2020) for primary studies investigating the management of NB in pediatric patients. Early management was defined as use of clean intermittent catheterization (CIC), and/or anticholinergics at presentation, or based on initial high-risk urodynamic findings. Outcomes included risk of secondary vesicoureteral reflux (VUR), upper urinary tract dilatation (UUTD), urinary tract infection (UTI), and renal deterioration on DMSA, which included renal scarring, or loss of differential renal function. The MA was conducted using RevMan 5. The risk of bias (ROB) of the studies was assessed using the ROBINS-I tool. 

Results: We included 8 cohort studies (583 participants, mean follow-up duration of 6.2 years) from 990 search results for the MA (Figure 1). Patients who received early management following initial assessment had significantly lower incidence of secondary VUR (0.33 [0.14, 0.74], p=0.007), UTI (0.40 [0.19, 0.85], p=0.02), and renal deterioration (0.39 [0.17, 0.91], p=0.03) compared to patients managed expectantly (Figure 2). There was no significant difference in the risk of UUTD (0.79 [0.09, 7.02], p=0.83). Finally, 3 and 5 of the 8 studies were ranked as having moderate and serious ROB, respectively.

Conclusion: Despite the high ROB of the studies, a signal favoring early management of NB in pediatric patients was detected. Expectantly managed NB patients potentially have a 2.5 times higher risk of secondary VUR, UTI, and renal deterioration during follow-up. Further randomized trials or well-defined prospective studies with long term follow-up should be conducted to confirm this finding.


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