Associations of ureteroceles location and system anatomy with outcomes of endoscopic treatment: A systematic review and meta-analysis

Introduction: Ureteroceles are a congenital abnormality of the ureter that can cause significant complications. Endoscopic treatment is a commonly used treatment approach. The aim of this review is to assess the results of endoscopic treatment for ureteroceles with consideration to their location and system anatomy. Methods: A meta-analysis was conducted by searching electronic databases for studies comparing outcomes of endoscopic treatment for ureteroceles. Newcastle–Ottawa Scale (NOS) was employed to evaluate the potential for bias. The primary outcome was the rate of secondary procedures required following endoscopic treatment. Secondary outcomes were inadequate drainage and post-operative vesicoureteral reflux (VUR) rates. A subgroup analysis was performed to investigate possible causes of heterogeneity in the primary outcome. The statistical analysis was conducted using Review Manager 5.4. Results: There were 28 retrospective observational studies, published between 1993 and 2022, including 1044 patients with primary outcomes in this meta-analysis. The quantitative synthesis showed that ectopic and duplex system ureteroceles were significantly associated with higher rate of secondary operation compared to intravesical and single system ureteroceles, respectively (OR: 5.42, 95% CI: 3.93–7.47; and OR: 5.10, 95% CI: 3.31–7.87). The associations were still significant in subgroup analysis based on follow up duration, average age at surgery, and duplex system only. For secondary outcomes, incidence of inadequate drainage were significantly higher in ectopic (OR: 2,01, 95% CI: 1.18–3.43), but not in duplex system ureteroceles (OR: 1.94, 95% CI: 0,97–3.86). Post-operative VUR rates were higher in both ectopic (OR: 1.79, 95% CI: 1.29–2.47) and duplex system ureteroceles group (OR: 1.88, 95% CI: 1.15–3.08). Conclusion: Ectopic ureteroceles and duplex system ureteroceles were associated with worse outcomes following endoscopic treatment compared to intravesical and single system ureteroceles, respectively. It is recommended to carefully select patients, conduct pre-operative evaluations, and closely monitor patients with ectopic and duplex system ureteroceles.