POCUS-guided suprapubic bladder aspiration in children: a systematic review and meta-analysis.

OBJECTIVE: Point-of-care ultrasound (POCUS) has been employed to assist with invasive techniques, such as suprapu-bic aspiration (SPA). We aimed to conduct a meta-analysis to compare the effectiveness of suprapubic bladder aspira-tion in children, with and without the use of POCUS. METHODS: We conducted a systematic search across the MEDLINE, EMBASE and Cochrane Central Register of Con-trolled Trials databases for articles published through February 2025. Eligible studies included randomized controlled trials (RCT) comparing SPA with and without POCUS in pediatric populations. Data extraction focused on overall pro-cedural success rates, as well as rates of success at first and second attempts. RESULTS: We analyzed seven trials collectively evaluating 468 suprapubic bladder aspirations. POCUS-guided SPA showed higher overall success rates (OR = 4.88; 95% CI: 2.36-10.09; p < 0.0001; I 2 = 10%). Although no significant difference was found in first-attempt success, POCUS improved success within two attempts (OR = 7.75; 95% CI: 1.54-39.09; p = 0.01; I 2 = 61%), although without significantly reducing the mean number of attempts. However, sensi-tivity analysis showed a benefit after the exclusion of one outlier study. CONCLUSIONS: POCUS improves SPA success in children and may enhance sterile urine collection, although training and equipment access remain challenges.