Comparison of resection and pyelotomic techniques for treating the recurrent pyeloureteral segment in children: A systematic review and meta-analysis

Abstract

Introduction. The lack of unified therapeutic and diagnostic protocol for managing children with relapsed obstruction of the pyeloureteral segment after ureteropyeloplasty has stimulated us to make a systematic review with meta-analysis on publications that studied indications and effectiveness of resection and endopyelotomic techniques.
 Material and methods. Primary selection found 276 and 1470 sources in PubMed and Google Scholar database. After reviewing them, five publications were taken for the analysis. The design of the articles was consistent with cohort studies.
 Results. The total number of patients with recurrent hydronephrosis was 156. All patients included in the review were children aged from 0 to 18 years. The present trial compared the effectiveness of resection and endopyelotomic techniques in treating recurrent hydronephrosis in children. When evaluating fixed effects in the model, the resection techniques showed a statistically significant increase in the weighted average risk of favorable outcomes by 68% (p = 0.001). The average follow-up period of patients after endopyelotomies was 36.6 months, and after resection pyeloplasty – 45.3 months. While analyzing complications, the majority of them predominated in the resection techniques. However, while performing the meta-analysis, this parameter turned out to be statistically insignificant (p = 0.55).
 Conclusion. The results obtained emphasize high effectiveness of resection techniques as a method for treating recurrent hydronephrosis in children; however, due to high heterogeneity of studies and due to the risk of publication bias, this systematic review requires inclusion of more studies with detailed characteristics of patients and static justification of curative modalities.