Comparative Outcomes of Laparoscopic, Retroperitoneoscopic, and One-Trocar-Assisted-Pyeloplasty in Pediatric Ureteropelvic Junction Obstruction: A Scoping Review of Literature.

Abstract

Introduction: Ureteropelvic junction obstruction (UPJO) is a common condition in pediatric urology, with various surgical techniques employed for treatment, including laparoscopic pyeloplasty (LP), retroperitoneoscopic pyeloplasty (RP), and One-Trocar-Assisted-Pyeloplasty (OTAP). This review compares intraoperative and postoperative complications, recurrence rates, and outcomes among these methods. Materials and Methods: A scoping review of the literature from 2000 to 2024 was conducted, analyzing studies on LP, RP, and OTAP in pediatric UPJO patients. We included studies in English and excluded those involving other surgical techniques and mixed adult-pediatric cases. Data extracted from eligible studies included the number of cases, patient age, operative time, complications, recurrence rates, and conversion to open surgery. Results: A review of 81 studies involving 3549 pediatric patients compared three surgical techniques: LP (2719 patients), RP (399 patients), and OTAP (476 patients). OTAP had the highest rates of minor intraoperative complications (8%) and conversions to open surgery (7.6%). LP and RP showed lower intraoperative complication rates (1.8% and 4.3%) and conversion rates (0.81% and 4.24%). Postoperative complications and recurrence rates were similar across all techniques, with OTAP having the fewest minor postoperative complications (0.8%) and the shortest surgical times (111.5 minutes). Conclusions: LP, RP, and OTAP are all effective treatments for pediatric UPJO, with comparable success rates and low recurrence rates. OTAP offers fewer minor postoperative complications in confront of LP and faster surgical times but has a higher conversion rate. LP and RP are more suitable for older patients, whereas OTAP seems to be more appropriate for younger patients.