Comparação entre cistostomia com ressecção tardia e ressecção endoscópica isolada no tratamento da válvula de uretra posterior: Uma meta-análise de desfechos renais em crianças
DOI:
https://doi.org/10.33448/rsd-v14i6.49095Palavras-chave:
Válvula de uretra posterior, Insuficiência renal terminal, Ressecção endoscópica, Cistostomia, Meta-análise.Resumo
O objetivo deste estudo foi realizar uma meta-análise para comparar os desfechos de IRT, medida pela TFG, em crianças com VUP tratadas com duas estratégias terapêuticas distintas: CT seguida de ressecção tardia (RT) e REI. Esta meta-análise comparou a eficácia da cistostomia com ressecção tardia (CTRT) e da ressecção endoscópica isolada (REI) na prevenção de insuficiência renal terminal (IRT) em crianças com válvula de uretra posterior (VUP). Foram incluídos 12 estudos (2011–2023), totalizando 770 pacientes, selecionados após triagem rigorosa de 1.904 registros. Os resultados mostraram que 29,28% das crianças submetidas à CTRT evoluíram para IRT, contra 18,15% no grupo REI, mas sem diferença estatisticamente significativa (diferença absoluta: -11,13%; IC 95%: -33,50% a 11,25%; *p* = 0,306). A análise sugere que ambas as abordagens têm eficácia clínica similar, com a escolha dependendo de fatores como gravidade da obstrução, recursos disponíveis e experiência do cirurgião. Em contextos de recursos limitados, a CTRT pode ser uma alternativa viável, enquanto a REI é preferível em centros especializados. Limitações incluem heterogeneidade dos estudos e falta de dados sobre gravidade da VUP. Conclui-se que a decisão terapêutica deve ser individualizada, reforçando a necessidade de estudos futuros com acompanhamento prolongado.
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