The optimal stent-strategy in paediatric pyeloplasty: a systematic review and network meta-analysis.
Ophelia Aubert, Samira M'Tiri, Andreas Kühnapfel et al.
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In 30 seconds
This systematic review and network meta-analysis compared internal JJ stents, external transanastomotic stents and stentless repair after Anderson-Hynes pyeloplasty in children with pelvi-ureteric junction obstruction. Across 26 studies involving 3298 children, operative success was high and overall complications did not differ significantly between strategies. Compared with stentless repair, both JJ and external stenting were associated with lower odds of major urine leakage or urinoma (OR 0.20, 95% CI 0.07-0.60; and OR 0.20, 95% CI 0.07-0.61, respectively). Evidence certainty was low or very low for most outcomes.
Key findings
- External stenting was associated with lower odds of major complications than no stenting (OR 0.56, 95% CI 0.33-0.93).
- JJ and external stenting were each associated with lower odds of major urine leakage or urinoma than stentless repair.
- JJ stenting was associated with higher odds of urinary tract infection or pyelonephritis than no stenting, but shorter hospital stay than external stenting.
- Overall complications and minor complications were similar between drainage strategies; operative success was high.
Why it matters
Drainage choice after paediatric pyeloplasty involves balancing potential reductions in leakage-related complications against infectious complications and differences in hospital stay. The review suggests that success is generally high across strategies, but the evidence does not establish one approach as best. Recognising the trade-offs can support informed, individualised decisions while accounting for the uncertainty in the available evidence.
What to keep in mind
The evidence certainty was low or very low for most outcomes, and the review included both randomised and non-randomised comparative studies.