Comparative analysis of laparoscopic and transumbilical incision open pyeloplasty for treatment of infants with ureteropelvic junction obstruction: a clinical efficacy and safety study.

Background: The treatment for the renal ureteropelvic junction obstruction (UPJO) is mainly dominated by laparoscopic minimally invasive techniques. Open surgery is used less frequently. However, in regions where endoscopic techniques are not yet well-developed or in very young infants, open pyeloplasty (OP) still plays a significant role. This study aims to investigate the clinical efficacy and safety of transumbilical incision open pyeloplasty (TUOP) in infants by comparing it with laparoscopic pyeloplasty (LP).

Methods: A retrospective analysis involving 40 infants (≤6 months) who underwent pyeloplasty at Department of Urology, Anhui Provincial Children's Hospital was conducted between April 2021 and April 2024. Eighteen infants were in the TUOP group, and 22 were in the LP group. After operation, the mean follow-up period of all infants was 18 (range, 6-28) months. The two groups were compared in terms of age, weight, operation time, duration of the indwelling catheter and peritoneal drainage, postoperative incision satisfaction, hospitalization costs and degree of recovery from postoperative hydronephrosis.

Results: There were no significant differences between the two groups in terms of the duration of abdominal drainage tubes used (P=0.67) or the duration of catheter retention (P=0.56). There were significant statistical differences between the two groups in terms of age (P=0.003), weight (P=0.02), operation time (P<0.001), postoperative incision satisfaction (P=0.03), and hospitalization costs (P=0.04). Compared with the preoperative results, the postoperative Society of Fetal Urology (SFU) grades were significantly improved in both groups.

Conclusions: Compared with the LP approach, TUOP treatment for infants with giant hydronephrosis is safe and effective, it has the advantages of a shorter surgical time, lower hospitalization costs, and involves an aesthetic and concealed incision. It is more worthy of promotion and application in younger infants or economically disadvantaged areas where endoscopic techniques are underdeveloped.