World journal of urology · 2026
What is the best surgical approach for redo pyeloplasty in children? A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод в очереди
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Bakr Ahmed M, Saleh Ahmed M, Abdelhalim Khaled M, Abdel-Karim Aly M
Аннотация
PURPOSE: Redo pyeloplasty in children is a challenging procedure that effectively corrects recurrent pelvi-ureteric junction obstruction (PUJO) and influences both renal function and development. There is no consensus on the best surgical approach that fulfils safety and efficacy standards. This study aims to compare open, laparoscopic, and robot-assisted laparoscopic (RAL) approaches in redo pyeloplasty for recurrent PUJO in children.
METHODS: PubMed and Scopus databases were searched for studies comparing different surgical approaches for redo pyeloplasty in children. Excluded were endoscopic treatments, comparisons with primary pyeloplasty, and studies including other complex renal anomalies. Risk of bias was assessed using the Newcastle-Ottawa score. Quantitative synthesis and forest plots were performed.
RESULTS: Four studies fulfilled the inclusion criteria out of 1,767 identified records, comparing laparoscopy (68 cases) with open approaches (78 cases); no RAL studies fulfilled the inclusion criteria. Three studies showed a moderate risk of bias (6/9), and one showed good quality (7/9). In the meta-analysis, laparoscopic and open approaches showed similar complication and success rates (p = 0.74 and 0.99, respectively), with no significant heterogeneity. Laparoscopic surgery was still longer than open surgery (p < 0.0001), with significant heterogeneity (I² = 63%, p = 0.04).
CONCLUSION: Laparoscopy appears to be safer and more successful than open surgery for redo pyeloplasty in children. However, the currently available evidence remains insufficient to strongly support or refute this. There is a paucity of evidence comparing the efficacy and safety of RAL with other approaches in these cases.
METHODS: PubMed and Scopus databases were searched for studies comparing different surgical approaches for redo pyeloplasty in children. Excluded were endoscopic treatments, comparisons with primary pyeloplasty, and studies including other complex renal anomalies. Risk of bias was assessed using the Newcastle-Ottawa score. Quantitative synthesis and forest plots were performed.
RESULTS: Four studies fulfilled the inclusion criteria out of 1,767 identified records, comparing laparoscopy (68 cases) with open approaches (78 cases); no RAL studies fulfilled the inclusion criteria. Three studies showed a moderate risk of bias (6/9), and one showed good quality (7/9). In the meta-analysis, laparoscopic and open approaches showed similar complication and success rates (p = 0.74 and 0.99, respectively), with no significant heterogeneity. Laparoscopic surgery was still longer than open surgery (p < 0.0001), with significant heterogeneity (I² = 63%, p = 0.04).
CONCLUSION: Laparoscopy appears to be safer and more successful than open surgery for redo pyeloplasty in children. However, the currently available evidence remains insufficient to strongly support or refute this. There is a paucity of evidence comparing the efficacy and safety of RAL with other approaches in these cases.