Comparative Analysis of Ureteral Reimplantation and Dextranomer/Hyaluronic Acid Injection Between Two Centers with Systematic Review and Meta-Analysis
Abstract
PURPOSE
Surgical management of pediatric vesicoureteral reflux (VUR) aims to reduce febrile urinary tract infections (fUTIs) while minimizing perioperative morbidity. We compared dextranomer/hyaluronic acid (Dx/HA) injection with ureteral reimplantation, focusing on durability, infectious outcomes, and perioperative burden.
METHODS
We conducted an era- and indication-matched retrospective two-center cohort study (January 2018-December 2025) of children <18 years treated for recurrent UTIs with Dx/HA or reimplantation, alongside a PRISMA-guided systematic review and meta-analysis (MEDLINE, Embase, Scopus; inception-December 2025; PROSPERO CRD420251154210). Outcomes included radiographic resolution, reoperation, postoperative fUTIs, operative time, and length of stay (LOS). Random-effects models were used; heterogeneity was assessed with tau2 and bias with RoB 2.0/ROBINS-I.
RESULTS
Institutional cohorts included 179 Dx/HA and 130 reimplantations. Dx/HA had shorter operative time (21 vs 140 min; p0.2). Postoperative UTI (19.6% vs 3.8%; p<0.001) and recurrent UTI (11.7% vs 1.5%; p<0.001) were higher after Dx/HA; procedure type independently predicted UTI (HR 5.6, 95% CI 2.1-14.6; p<0.001). Meta-analysis (15 studies) favored reimplantation for radiographic resolution (RR for non-resolution 4.30; p=0.0003; tau2=0.44) and reoperation (RR 6.42; p<0.00001; tau2=0.20), while febrile/recurrent UTI did not differ (tau2=1.12). Evidence certainty was limited by heterogeneity and…
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