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Published on: July 8, 2025
The optimal stent-strategy in paediatric pyeloplasty: a systematic review and network meta-analysis
Ophelia Aubert1, Samira M'Tiri1, Andreas Kühnapfel2
1Department of Pediatric Surgery, University of Heidelberg, University Hospital Mannheim, Mannheim, Germany.
Insights
For pediatric pyeloplasty, stenting strategies offer similar success rates. While stenting may reduce leakage, JJ stents can increase infection risk, suggesting individualized drainage approaches are best.
Area of Science:
- Pediatric Urology
- Surgical Techniques
- Evidence-Based Medicine
Background:
- Pelvi-ureteric junction (PUJ) obstruction is a common cause of pediatric kidney issues.
- Anderson-Hynes pyeloplasty is a standard surgical repair for PUJ obstruction.
- The optimal drainage strategy following pyeloplasty remains debated.
Purpose of the Study:
- To compare the efficacy and safety of internal JJ stenting, external transanastomotic stenting, and stentless repair in pediatric pyeloplasty.
- To evaluate complication rates and operative success across different drainage methods.
Main Methods:
- Systematic review and network meta-analysis of randomized and non-randomized comparative studies.
- Inclusion of studies involving children undergoing Anderson-Hynes pyeloplasty for PUJ obstruction.
- Analysis of data from MEDLINE, EMBASE, Cochrane Library, and Web of Science databases.
Main Results:
- High overall operative success rates observed across all drainage strategies.
- External stenting showed lower odds of major complications compared to no stenting.
- Both JJ and external stenting reduced major urine leakage/urinoma compared to stentless repair.
- JJ stenting was linked to increased urinary tract infections but shorter hospital stays than external stenting.
Conclusions:
- Pediatric pyeloplasty demonstrates high success irrespective of the drainage method.
- Stented approaches may mitigate leakage complications, but JJ stents carry a higher infection risk.
- Individualized selection of drainage strategy is recommended based on patient factors.
Objectives:
To compare internal JJ stenting, external transanastomotic stenting and stentless repair after Anderson-Hynes pyeloplasty in children.
Patients And Methods:
A systematic review and network meta-analysis of children with pelvi-ureteric junction (PUJ) obstruction undergoing Anderson-Hynes pyeloplasty. The MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched from inception to February 2025. Randomised and non-randomised comparative studies were included. Network meta-analysis compared JJ stenting, external stenting and no stenting. Risk of bias and certainty of evidence were assessed.
Results:
A total of 26 studies including 3298 children were analysed. Overall complications did not differ significantly between strategies and operative success was high. External stenting was associated with lower odds of major complications compared with no stenting (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33-0.93). The JJ and external stenting were associated with lower odds of major urine leakage or urinoma compared with stentless repair (OR 0.20, 95% CI 0.07-0.60; and OR 0.20, 95% CI 0.07-0.61, respectively). Minor complications were similar between strategies, as were stent-related complications between JJ and external stenting. JJ stenting was associated with higher odds of urinary tract infection or pyelonephritis compared with no stenting, but with shorter hospital stay compared with external stenting. Certainty of evidence was low or very low for most outcomes.
Conclusion:
Paediatric pyeloplasty achieves high success rates regardless of drainage strategy. Stented approaches may reduce major leakage-related complications compared with stentless repair, while JJ stents may increase infectious complications. Drainage strategy should remain individualised.