The outcome of stenting and its duration after pyeloplasty in children with ureteropelvic junction obstruction (UPJO): a systematic review and meta-analysis

Abstract

Background: 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. Methods: A 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. Results: Eleven 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). Conclusion: The 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.