Comparison of outcomes of open, laparoscopic, and robot-assisted laparoscopic pyeloplasty in children with pelviureteric junction obstruction: a systematic review and meta-analysis
TL;DR
All approaches achieve high success with comparable complication profiles, particularly RALP, and minimally invasive techniques, particularly RALP, are associated with shorter hospital stay.
Abstract
Background Pelviureteric junction obstruction (PUJO) is a leading cause of hydronephrosis in children, and pyeloplasty remains the most frequently performed robot-assisted procedure in this population. This systematic review and meta-analysis aimed to compare outcomes and complication rates across open pyeloplasty (OP), laparoscopic pyeloplasty (LP), and robot-assisted laparoscopic pyeloplasty (RALP). Methods The PRISMA guidelines were followed. No external funding was received. MEDLINE, PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched up to February 2026. Studies including ≥10 patients aged <16 years who underwent dismembered pyeloplasty were eligible. Risk of bias (RoB) was assessed using RoB 2, the Newcastle-Ottawa Scale, and JBI tools. Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Thirty-eight studies (n=3,159) met the inclusion criteria; 13 were meta-analysed. LP demonstrated longer operative time than OP [mean difference (MD), 21.58 min, 95% confidence interval (CI): 4.28–38.88] (P=0.01). Operative time was comparable between RALP and LP (MD, −1.92 min, 95% CI: −45.75 to 41.72) (P=0.93). LP was associated with shorter hospital stay than OP (MD, −2.33 days, 95% CI: −4.61 to −0.05) (P=0.04). RALP showed reduced length of stay (LOS) compared to LP (MD, −0.89, 95% CI: −1.35 to −0.36) (P=0.0007). Success rates were comparable between OP and LP and between OP and RALP; RALP demonstrated higher success rates when compared to LP [odds ratio (OR) 2.78, 95% CI: 1.09–7.11] (P=0.03). Minor and major complication rates were comparable across all approaches. Certainty of evidence ranged from low to very low across outcomes. Conclusions All approaches achieve high success with comparable complication profiles. Minimally invasive techniques, particularly RALP, are associated with shorter hospital stay. Higher-quality prospective data are needed.