The Comparison Of Polyacrylate-polyalcohol Copolymer(PPC)and Dextranomer-hyaluronic Acid Copolymer(Dx/HA)in Endoscopic Treatment Of Vesicoureteral Reflux:A Meta-analysis

Objective:The safety and effectiveness of the endoscopic injection material polyacrylate-p olyalcohol copolymer(PPC)in the treatment of vesicoureteral reflux have been conf irmed,but compared with the dextranomer/hyaluronic acid copolymer(Dx/HA),the advantages of PPC is still controversial.This article compares the efficacy of the t wo implants in the treatment of vesicoureteral reflux through the method of Meta-a nalysis.Methods:Using computer to search PubMed、Cochrane Library、Embase,、Web of Scien ce、CNKI、VIP、CBM and Wanfang database,and the publication period of the liter ature is from January 2010 to February 2021.The literature was strictly screened a ccording to the inclusion and exclusion criteria.The randomized controlled experimen t used Revman5.3 software(from the Cochrane Collaboration)to evaluate the qualit y of literature,and the retrospective cohort study used the NOS tool to evaluate its quality.Extracting the basic information included in the study.The outcome indicator s were the success rate of surgery and the incidence of ureteral obstruction during postoperative follow-up.The data were analyzed by using Revman5.3 software.Results:⑴A total of 9 English literatures that including 8 retrospective cohort studies a nd 1 randomized controlled trial were included.There were 3413 reflux patients,in cluding 2227 in the Dx/HA group and 1186 in the PPC group.⑵The results of M eta-analysis showed that there was no significant difference between PPC and Dx/H A in the efficacy in Ⅲ reflux(OR=2.68,95%CI: 0.85-8.44,P=0.09).In Ⅳ-Ⅴ grade reflux(OR=3.12,95%CI=1.56-6.24,P=0.001),overall success rate(OR=2.79,95%CI):1.77-4.40,P<0.0001),and the success rate of the first injection(OR=4.96,95%CI: 3.38-7.28,P<0.00001),PPC is higher than Dx/HA.But compared with Dx/H A,PPC increased the risk of postoperative ureteral obstruction(OR=3.06,95%CI:1.61-5.78,P=0.0006).Conclusion:Compared with dextranomer/hyaluronic acid copolymer,polyacrylate-polyalcohol copolymer has a higher success rate,especially in high-grade reflux patients,the cu rative effect of polyacrylate-polyalcohol copolymer is significantly better than that o f dextranomer/hyaluronic acid copolymer.However,compared with glycan anhydride hyaluronic acid copolymer,polyacrylate-polyalcohol copolymer will increase the risk of postoperative ureteral obstruction.