Department of Urology, University Medical Center Goettingen, Goettingen, Germany.
Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany.
BMC Urol. 2019 Nov 11;19(1):112. doi: 10.1186/s12894-019-0544-7.
Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach.
A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques.
A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05-0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31-0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41-0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22-0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min-163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min-164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min-151.58 min, p = 0.003).
Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.
治疗肾盂输尿管连接部梗阻（UPJO）有多种手术治疗选择。本研究的目的是在综合网络方法中比较最常使用的技术。
2018 年 1 月对 EMBASE、MEDLINE 和 Cochrane 数据库进行了系统的文献检索。评估了至少两种以下手术技术的出版物：开放肾盂成形术（OP）、内切开术（EP）、腹腔镜（LP）和机器人辅助肾盂成形术（RP）。主要结局为手术成功率、并发症、尿漏、再次手术、输血率、手术时间和住院时间。网络荟萃分析采用随机效应模型同时评估所有手术技术的效果。
共分析了 26 项研究，包括 3143 名患者。与 RP 相比，EP 和 LP 的手术成功率较低（EP：OR=0.09，95%CI：0.05-0.19；p<0.001；LP：OR=0.51，95%CI：0.31-0.84；p=0.008）。与 OP 相比，LP 和 RP 的并发症风险较低（LP：OR=0.62；95%CI：0.41-0.95；p=0.027；RP：OR=0.41；95%CI：0.22-0.79；p=0.007）。与 RP 相比，尿漏或再次手术、输血率无显著差异。与 EP 相比，RP 的手术时间较长（平均=102.87 分钟，95%CI：41.79 分钟-163.95 分钟，p<0.001）。进一步发现 LP 与 EP 相比（平均=115.13 分钟，95%CI：65.63 分钟-164.63 分钟，p<0.001）和 OP 与 EP 相比（平均=91.96 分钟，95%CI：32.33 分钟-151.58 分钟，p=0.003），手术时间有显著差异。
治疗 UPJO 有多种手术技术。RP 的手术成功率最高，LP 的并发症发生率也低于 OP。虽然 EP 的手术效果较差，但手术时间短于 OP、RP 和 LP。外科医生在为个体患者选择最佳治疗方法时应考虑这些发现。
