The outcome of stenting and its duration after pyeloplasty in children with ureteropelvic junction obstruction (UPJO): a systematic review and meta-analysis
摘要
The complication related to the use of stent and its duration are still considered in the treatment option of UPJO despite the high success rates of several pyeloplasty techniques.
MethodsA systematic search was performed using PubMed/MEDLINE, ScienceDirect, and Cochrane databases, selecting cohort and controlled trial studies until April 2023. The following medical subject headings (MeSH) were included in the search: stent, ureteropelvic junction obstruction, pyeloplasty and children. Complication and success rate related to the stent placement after pyeloplasty were recorded.
ResultsEleven studies including 1072 patients were included. Eight studies compared stented versus non-stented pyeloplasty. Three studies compared 4-week stenting vs ≤ 2-week stenting. The total complication risk is decreased in stented group compared to non-stented group (OR 0.81, 95% CI 0.59–1.13). According to subgroup analysis, urinary leakage (OR 0.21 95% CI 0.10–0.47) and obstruction (OR 0.69 95% CI 0.32–1.47) are decreased in stented group. The total risk of complication is increased in 4-week stenting period (OR 5.11, 95% CI 2.43- 10.74) compared to ≤ 2-week stenting period, with the OR of each subgroup analysis is 4.64, 95% CI 1.8–11.97; 4.36, 95% CI 0.5–38.3 and 6.78, 95% CI 1.65–27.92 for fever, stent migration, and irritative symptom, respectively. There were no differences of success rate among the groups (OR 0.48, 95% CI 0.04–5.62).
ConclusionThe use of stent can reduce the risk of urinary leakage after pyeloplasty in children. Stenting duration ≤ 2 weeks carries a smaller risk of complications with the same post operative success rate as stents with a longer duration.