Postoperative antibiotic prophylaxis following pyeloplasty in children with ureteropelvic junction obstruction: evidence from a systematic review and meta-analysis.

BACKGROUND

Ureteropelvic junction obstruction (UPJO) is a common pediatric urological anomaly often treated with pyeloplasty. Postoperative urinary tract infection (UTI) is a recognized complication, frequently prompting routine antibiotic prophylaxis despite limited evidence and growing concerns over antibiotic resistance. We aim to evaluate whether postoperative antibiotic prophylaxis reduces UTI incidence following pediatric pyeloplasty for UPJO.

METHODS

A systematic review and meta-analysis was conducted as per PRISMA guidelines (CRD42024550087). PubMed, Web of Science, Scopus, and EMBASE were searched (January 1990-May 2025) for relevant studies comparing postoperative antibiotic prophylaxis with no prophylaxis in children < 18 years undergoing pyeloplasty. Primary outcome was postoperative UTI incidence. Risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and RoB 2 for randomized trials. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model.

RESULTS

Fourteen studies (n = 3,587 patients; 3,589 pyeloplasties) were included; five provided comparative data for meta-analysis. Postoperative prophylaxis was administered in 67.3% of cases. The overall incidence of UTI in the prophylaxis group was 8.7%. Meta-analysis (five studies; n = 2,279) showed no significant difference in UTI incidence between the two groups (RR 1.19, 95% CI 0.92-1.56; p = 0.19; I²=0%). Most pyeloplasties (91.5%) involved double-J stents, typically removed within 4-6 weeks. Data on antibiotic type, regimen, and duration were variably reported.

CONCLUSIONS

Postoperative antibiotic prophylaxis after pediatric pyeloplasty does not significantly reduce UTI incidence. These findings support reconsideration of blanket antibiotic use in favour of targeted prophylaxis, such as peri-procedural coverage at stent removal, aligning with antibiotic stewardship principles. Limited data precluded analysis of potentially influential factors, including stent type/duration, antibiotic regimen, and surgical approach. Future well-designed studies should address these gaps to optimize prophylaxis strategies.