Systematic Review and Meta-analysis Comparing Outcomes of Reduction versus Nonreduction Pyeloplasty in Children

Abstract

Background and Aims: There is no robust data to support the practice of not reducing the pelvis during laparoscopic/robotic pyeloplasty. Very few authors have compared reduction pyeloplasty (RP) against nonreduction pyeloplasty (NRP). Methods: Databases were searched using the terms: Pyeloplasty AND (reduction vs. no reduction of pelvis) AND outcome to identify all papers pertaining to pyeloplasty outcomes in the pediatric population. Meta-analysis of proportions was carried out using MetaXL 5.3 and an odds ratio plot was constructed using Review Manager (RevMan) Version 5.4. Results: = 116), 5 articles were included. In four studies (pelvis size <40 mm), there was no recurrence in either the RP or NRP group. Only in one study (pelvis size >40-50 mm), there were slightly higher odds of failure with NRP (2/20 RP vs. 3/20 NRP; odds ratio 0.63). There was no significant difference in pooled failure rate between RP and NRP in this meta-analysis. Improvement in renal pelvis size or drainage curve after surgery was faster in the RP group, but during late follow-up, this advantage was not obvious. There was no significant difference in functional recovery between RP and NRP. Conclusions: In cases with a large renal pelvis (>40-50 mm), one may elect for RP, while in the remaining, one may resort to NRP. Larger randomized controlled trials are necessary to better understand the impact of pelvic reduction on outcomes in pyeloplasty.