Predictors of Complications after Pediatric Pyeloplasty: A Retrospective Cohort Study and Meta-Analysis

Pyeloplasty is the gold standard procedure for treating ureteropelvic junction obstruction (UPJO), but the occurrence of postoperative complications is a major challenge. This study aimed to identify the predictors of postpyeloplasty complications, which are not well characterized in contemporary literature.

We retrospectively analyzed data of children who underwent pyeloplasty in our hospital from January 2011 to August 2022, with a minimum follow-up of 1 year. Furthermore, a systematic review and meta-analysis of studies published from 2000 to 2023 was performed to identify predictors of complications.

In cohort studies (n = 555), preoperative urinary tract infection (pre-UTI) (odds ratio [OR] = 5.65, 95% confidence interval [CI]: 2.96-10.78, p < 0.001), Double J-stent duration (OR = 1.005, 95% CI: 1.001-1.008, p = 0.005), renal cortical thickness (OR = 0.181, 95% CI: 0.071-0.461, p < 0.001), and collection system separation (OR = 1.170, 95% CI: 1.017-1.347, p = 0.028) were associated with total postoperative complications. Pre-UTI (OR = 4.87, 95% CI: 1.98-11.98, p = 0.001), Double J-stent duration (OR = 1.005, 95% CI: 1.001-1.009, p = 0.019), preoperative renal cortical thickness (OR = 0.197, 95% CI: 0.042-0.928, p = 0.040), and duration of operation (OR = 1.013, 95% CI: 1.003-1.022, p = 0.008) were associated with recurrence. Pre-UTI (OR = 5.33, 95% CI: 2.73-10.38, p < 0.001) and preoperative renal cortical thickness (OR = 0.351, 95% CI: 0.124-0.990, p = 0.048) were predictors of postoperative UTI. In the meta-analysis, sex (I² = 0%, relative risk [RR] = 1.19, 95% CI: 1.01-1.40, p = 0.04), operation methods, and split renal function (I² = 50%, RR = 0.76, 95% CI: 0.59-0.96, p = 0.02) were identified as predictors of postoperative complications.

We identified the predictors of postpyeloplasty complications. Early identification and treatment can help us reduce the incidence of complications.