ESPU Congress 2018 - Abstract Book

CONGRESS OF THE ESPU

09:22–09:25

S5-7 (PP)

A META-ANALYSIS OF THE FATE OF CONTRALATERAL

VESICO-URETERAL REFLUX IN UNILATERAL MULTICYSTIC

DYSPLASTIC KIDNEY

Tomer ERLICH

and Luis BRAGA

1) Sheba medical center Tel Hashomer, Urology, Ramat Gan, ISRAEL - 2) McMaster Children Hospital, McMaster

University, Surgery, Hamilton, CANADA

PURPOSE

To describe the incidence, management (continuous antibiotic prophylaxis (CAP) use and surgical

interventions) and evolution (UTI and spontaneous resolution rates) of each vesico-ureteral reflux

(VUR) grade in the contralateral kidney of unilateral multicystic dysplastic kidney (MCDK) patients,

in order to strengthen the scientific basis regarding the need for voiding cystourethrography (VCUG)

screening.

MATERIAL AND METHODS

A comprehensive search of MEDLINE, EMBASE, CINHAL, WEB OF SCIENCE, COCHRANE and

gray literature was performed (1950 – July 2015). Full-text screening, data abstraction and quality

appraisal were conducted in duplicate. Included studies reported a primary diagnosis of unilateral

MCDK with contralateral VUR determined by VCUG. Articles had to include a distribution of VUR

grade to meet the eligibility criteria.

RESULTS

From 657 retrieved articles, 37 studies enrolling 2057 patients were analyzed. 87 % (80–92 %)

were diagnosed with MCDK prenatally (80 % males). 1800 patients had VCUG, 303 had VUR

(weighted proportion 17 %; 95 % CI: 14 %–20). Weighted proportions of VUR were 9 %, 7 % and

17 % for grades I–II, III–V, and I–V, respectively. 99 % of patients were on CAP and 18 % (95 %

CI: 8–37 %) had UTIs, with a higher rate of UTIs (23 % vs 10 %) in patients with dilating (grades

3–5) VUR, over a mean follow-up of 40 months. In patients with dilating VUR, reflux resolved or

downgraded to grade I in 52 % of patients, and 11 % had surgical correction of VUR.

CONCLUSIONS

Dilating VUR proportion is significant (7 %) in the contralateral functioning kidney of patients with

unilateral MCDK but due to lack of sufficient conclusive data, VCUG screening cannot be explicitly

recommended.