Abstract
BackgroundMultiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach.MethodsA systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques.ResultsA total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003).ConclusionsMultiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.
Highlights
Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO)
Studies had to assess at least one of the following outcomes: operative success, operating time, suturing time, estimated blood loss, transfusion rate, conversion rate, re-operation rate, intra- and postoperative as well as overall complications, urinary leakage, deaths, length of hospital stay, time to return to normal activities, renal function, pain, analgesia requirement, survival time and costs
Operative success and complications were evaluated by 24 studies each, whereas operating time was reported by 22 studies and length of hospital stay by 21 studies
Summary
Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). Several studies reported that minimal invasive treatment options outperform open pyeloplasty (OP) with respect to early recovery and lower complication rates, whereas OP operating time is shorter [3, 4]. Notwithstanding that metaanalyses have been published comparing individual studies for two treatment options, these provides limited guidance in the current situation with multiple approaches available for UPJO which must be evaluated against each another. The aim of this network-meat analysis is to provide a comprehensive overview for most frequently used techniques for treatment of UPJO and to compare their effectiveness regarding various clinically important outcomes
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