Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis

Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO).Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis.Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation.Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.