Russian Journal of Pediatric SurgeryRussian Journal of Pediatric SurgeryДетская хирургия1560-95102412-0677Eco-Vector64210.55308/1560-9510-2023-27-5-343-352ReviewsОБЗОРЫReview ArticleComparison of resection and pyelotomic techniques for treating the recurrent pyeloureteral segment in children: A systematic review and meta-analysisСравнение резекционных и эндопиелотомических методов лечения рецидивирующей обструкции пиелоуретерального сегмента у детей: систематический обзор и мета-анализhttps://orcid.org/0000-0003-4367-7153PetrovaAysel F.ПетроваАйсель Фаризовна
Russian Federation

department of pediatric surgery, Pirogov Russian National Research Medical University

врач-детский хирург, эндоскопист, соискатель кафедры детской хирургии имени академика Ю.Ф. Исакова ФГАОУ ВО «РНИМУ им. Н.И. Пирогова» МЗ РФ

aysel1494@gmail.comhttps://orcid.org/0000-0001-6310-7110KovarskiyS. L.КоварскийС. Л.
Russian Federation

Кафедра детской хирургии имени академика Ю.Ф. Исакова

aysel1494@gmail.comhttps://orcid.org/0009-0001-4368-4022PetrovA. V.ПетровА. В.
Russian Federation

Кафедра детской хирургии имени академика Ю.Ф. Исакова

aysel1494@gmail.comPirogov Russian National Research Medical UniversityФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской ФедерацииFilatov Children’s Municipal HospitalГБУЗ города Москвы «Детская городская клиническая больница имени Н.Ф. Филатова» Департамента здравоохранения города Москвы071220232753433522903202328102023Copyright ©; 2023, Petrova A.F., Kovarskiy S.L., Petrov A.V.Copyright ©; 2023, Петрова А.Ф., Коварский С.Л., Петров А.В.2023Petrova A.F., Kovarskiy S.L., Petrov A.V.Петрова А.Ф., Коварский С.Л., Петров А.В.https://jps-nmp.ru/jour/article/view/642

Introduction. The lack of unified therapeutic and diagnostic protocol for managing children with relapsed obstruction of the pyeloureteral segment after ureteropyeloplasty has stimulated us to make a systematic review with meta-analysis on publications that studied indications and effectiveness of resection and endopyelotomic techniques.

Material and methods. Primary selection found 276 and 1470 sources in PubMed and Google Scholar database. After reviewing them, five publications were taken for the analysis. The design of the articles was consistent with cohort studies.

Results. The total number of patients with recurrent hydronephrosis was 156. All patients included in the review were children aged from 0 to 18 years. The present trial compared the effectiveness of resection and endopyelotomic techniques in treating recurrent hydronephrosis in children. When evaluating fixed effects in the model, the resection techniques showed a statistically significant increase in the weighted average risk of favorable outcomes by 68% (p = 0.001). The average follow-up period of patients after endopyelotomies was 36.6 months, and after resection pyeloplasty – 45.3 months. While analyzing complications, the majority of them predominated in the resection techniques. However, while performing the meta-analysis, this parameter turned out to be statistically insignificant (p = 0.55).

Conclusion. The results obtained emphasize high effectiveness of resection techniques as a method for treating recurrent hydronephrosis in children; however, due to high heterogeneity of studies and due to the risk of publication bias, this systematic review requires inclusion of more studies with detailed characteristics of patients and static justification of curative modalities.

Введение. Отсутствие единого лечебно-диагностического протокола ведения детей с повторной обструкцией пиелоуретерального сегмента после уретеропиелопластики побудило нас провести систематический обзор с мета-анализом публикаций, в которых изучались показания и эффективность резекционных и эндопиелотомических методов.

Материал и методы. При первичном отборе было найдено 276 и 1470 результатов с помощью баз данных PubMed и Google Scholar соответственно. Из первоначально идентифицированных результатов поиска проведён анализ 5 статей. Дизайн статей соответствовал когортным исследованиям.

Результаты. Общее количество пациентов с рецидивом гидронефроза составило 156. Все включённые в настоящий обзор пациенты были детьми от 0 до 18 лет. В исследованиях проводилось сравнение успешности резекционных и эндопиелотомических методов лечения рецидива гидронефроза у детей. Применение первых сопровождалось статистически значимым возрастанием средневзвешенного риска благоприятного исхода на 68% (p = 0,001) при оценке в модели фиксированных эффектов. Средний срок наблюдения пациентов после эндопиелотомий составил 36,6 мес, в то время как после резекционных пиелопластик – 45,3 мес. При анализе осложнений превалирующее большинство пришлось на долю резекционных методов. Однако при выполнении мета-анализа данный факт оказался статистически не значимым (p = 0,55).

Заключение. Полученные результаты подчёркивают высокую эффективность резекционных методик в качестве метода лечения рецидива гидронефроза у детей, однако, в связи с высокой гетерогенностью исследований и риском публикационного смещения, данный систематический обзор требует включения большего количества исследований с развёрнутой характеристикой пациентов и статическим обоснованием методов лечения.

congenital hydronephrosischildrenhydronephrosis relapsefailed pyeloplastyre-obstruction of ureteropelvic junctionsecondary obstruction of pyeloureteral segmentврождённый гидронефроз у детейрецидив гидронефроза у детейнеудачная пиелопластикаповторная обструкция пиелоуретерального сегментавторичная обструкция пиелоуретерального сегментаAbdel-Karim A.M., Fahmy A., Moussa A., Rashad H., Elbadry M., Badawy H., Hammady A. Laparoscopic pyeloplasty versus open pyeloplasty for recurrent ureteropelvic junction obstruction in children. Journal of Pediatric Urology. 2016; 12(6): 401.e1–401.e6. https://doi.org/10.1016/j.jpurol.2016.06.010Abdrabuh A.M., Salih E.M., Aboelnasr M., et al. Endopyelotomy versus redo pyeoloplasty for management of failed pyeloplasty in children: A single center experience. Journal of Pediatric Surgery. 2018; 53(1): 2250–5. https://doi.org/10.1016/j.jpedsurg.2018.06.002Abraham G.P., Siddaiah A.T., Ramaswami K., et al. Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty. Urology Annals. 2015; 7(2): 183–7. https://doi.org/10.4103/0974-7796.150489Atug F., Woods M., Burgess S.V., Castle E.P., Thomas R. Robotic assisted laparoscopic pyeloplasty in children. J Urol. 2005; 174(4 Pt 1): 1440–2. https://doi.org/10.1097/01.ju.0000173131.64558.c9Badlani G., Eshghi M., Smith A.D. Percutaneous surgery for ureteropelvic junction obstruction (endopyelotomy): Technique and early results. Journal of Urology. 1986; 135(1): 26–8. https://doi.org/10.1016/S0022-5347(17)45503-0Basiri A., Behjati S., Zand S., Moghaddam S.M.H. Laparoscopic pyeloplasty in secondary ureteropelvic junction obstruction after failed open surgery. Journal of Endourology. 2007; 21(9): 1045–51. https://doi.org/10.1089/end.2006.0414Boylu U., Thomas R. Retrograde Ureteroscopic Endopyelotomy for Ureteropelvic Junction Obstruction. Smith’s Textbook of Endourology: 3rd Edition. Wiley-Blackwell, 2012; (1): 453–60. https://doi.org/10.1002/9781444345148.CH42Braga L.H.P., Lorenzo A.J., Skeldon S., et al. Failed pyeloplasty in children: comparative analysis of retrograde endopyelotomy versus redo pyeloplasty. Journal of Urology. 2007; 178(6): 2571–5. https://doi.org/10.1016/j.juro.2007.08.050Ceyhan E., Dogan H.S., Tekgul S. Our experience on management of failed pediatric pyeloplasty. Pediatric Surgery International. 2020; 36(8): 971–6. https://doi.org/10.1007/S00383-020-04699-9Davis T.D., Burns A.S., Corbett S.T., Peters C.A. Reoperative robotic pyeloplasty in children. Journal of Pediatric Urology. 2016; 12(6): 394.e1–394.e7. https://doi.org/10.1016/j.jpurol.2016.04.045Grazia E., Nicolosi D. Di Ureteroscopic laser endopyelotomy in secondary UPJ obstruction after pyeloplasty failure. Urologia Internationalis. 2005; 75(4): 333–6. https://doi.org/10.1159/000089169Dy G.W., Hsi R.S., Holt S.K., et al. National trends in secondary procedures following pediatric pyeloplasty. Journal of Urology. 2016; 195(4): 1209–14. https://doi.org/10.1016/j.juro.2015.11.010Faerber G.J., Ritchey M.L., Bloom D.A. Percutaneous endopyelotomy in infants and young children after failed open pyeloplasty. The Journal of Urology. 1995; 154(4): 1495–7. https://doi.org/10.1016/S0022-5347(01)66912-XFigenshau R.S., Clayman R.V. Endourologic options for management of ureteropelvic junction obstruction in the pediatric patient. Urologic Clinics of North America. 1998; 25(2): 199–209. https://doi.org/10.1016/S0094-0143(05)70008-2Helmy T.E., Sarhan O.M., Hafez A.T., et al. Surgical management of failed pyeloplasty in children: Single-center experience. Journal of Pediatric Urology. 2009; 5(2): 87–9. https://doi.org/10.1016/j.jpurol.2008.09.001Hoenig D.M., Shalhav A.L., Elbahnasy A.M., et al. Impact of etiology of secondary ureteropelvic junction obstruction on outcome of endopyelotomy. Journal of Endourology. 1998; 12(2): 131–3. https://doi.org/10.1089/end.1998.12.131Hsi R.S., Holt S.K., Gore J.L., et al. National trends in followup imaging after pyeloplasty in children in the United States. Journal of Urology. 2015; 194(3): 777–82. https://doi.org/10.1016/j.juro.2015.03.123Jabbour M.E., Goldfischer E.R., Anderson A.E., et al. Failed endopyelotomy: Low expression of TGFβ regardless of the presence or absence of crossing vessels. Journal of Endourology. 1999; 13(4): 295–8. https://doi.org/10.1089/end.1999.13.295Leung L., Chan I.H.Y., Chung P.H.Y., et al. Outcomes of re-intervention for laparoscopic transperitoneal pyeloplasty in children. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2016; 26(4): 318–23. https://doi.org/10.1089/lap.2015.0095Lindgren B.W., Hagerty J., Meyer T., et al. Robot-assisted laparoscopic reoperative repair for failed pyeloplasty in children: A safe and highly effective treatment option. Journal of Urology. 2012; 188(3): 932–7. https://doi.org/10.1016/j.juro.2012.04.118Lim D.J., Walker R.D. Management of the failed pyeloplasty. The Journal of urology. 1996; 156(2 Pt 2): 738–40. https://doi.org/10.1097/00005392-199608001-00048Netto N.R., Ikari O., Esteves S.C., et al. Antegrade endopyelotomy for pelvi-ureteric junction obstruction in children. British Journal of Urology. 1996; 78(4): 607–12. https://doi.org/10.1046/j.1464-410x.1996.16419.xParente A., Angulo J.M., Burgos L., et al. Percutaneous endopyelotomy over high pressure balloon for recurrent ureteropelvic junction obstruction in children. Journal of Urology. 2015; 194(1): 184–9. https://doi.org/10.1016/j.juro.2015.01.074Park J., Kim W.S., Hong B., et al. Long-term outcome of secondary endopyelotomy after failed primary intervention for ureteropelvic junction obstruction. International Journal of Urology. 2008; 5(6): 490–4. https://doi.org/10.1111/j.1442-2042.2008.02035.xPasserotti C.C., Nguyen H.T., Eisner B.H., Lee R.S., Peters C.A. Laparoscopic reoperative pediatric pyeloplasty with robotic assistance. J Endourol. 2007; 21(10): 1137–40. https://doi.org/10.1089/end.2007.9929Patel T., Kellner C.P., Katsumi H., Gupta M. Efficacy of endopyelotomy in patients with secondary ureteropelvic junction obstruction. J Endourol. 2011; 25(4): 587–91. https://doi.org/10.1089/end.2010.0026Persky L., McDougal W.S., Kedia K. Management of initial pyeloplasty failure. Journal of Urology. 1981; 125(5): 695–7. https://doi.org/10.1016/S0022-5347(17)55166-6Reis L.O., Ikari O., Zani E.L., et al. Long-term results of anderson-hynes pyeloplasty in children: How long follow-up is necessary? European Journal of Pediatric Surgery. 2014; 25(6): 509–12. https://doi.org/10.1055/s-0034-1390018Romao R.L.P., Koyle M.A., Pippi Salle J.L., et al. Failed pyeloplasty in children: Revisiting the unknown. Urology. 2013; 82(5): 1145–9. https://doi.org/10.1016/j.urology.2013.06.049Seo I.Y., Oh T.H., Lee J.W. Long-term follow-up results of laparoscopic pyeloplasty. Korean Journal of Urology. 2014; 55(10): 656–9. https://doi.org/10.4111/kju.2014.55.10.656Sergi F., Flammia G.P., Alcini A., et al. Collagen changes in the ureteropelvic junction after failed antegrade endopyelotomy. Journal of Endourology. 2007; 21(1): 103–7. https://doi.org/10.1089/end.2006.9996Shapiro E.Y., Cho J.S., Srinivasan A., et al. Long-Term Follow-Up for Salvage Laparoscopic Pyeloplasty After Failed Open Pyeloplasty. Urology. 2009; 73(1): 115–8. https://doi.org/10.1016/j.urology.2008.08.483Thomas J.C., DeMarco R.T., Donohoe J.M., et al. Management of the failed pyeloplasty: A contemporary review. Journal of Urology. 2005; 174(6): 2363–6. https://doi.org/10.1097/01.ju.0000180420.11915.31Varkarakis I.M., Bhayani S.B., Allaf M.E., et al. Management of secondary ureteropelvic junction obstruction after failed primary laparoscopic pyeloplasty. The Journal of urology. 2004; 172(1): 180–2. https://doi.org/10.1097/01.ju.0000132142.25717.08Veenboer P.W., Chrzan R., Dik P., et al. Secondary endoscopic pyelotomy in children with failed pyeloplasty. Urology. 2011; 77(6): 1450–4. https://doi.org/10.1016/j.urology.2010.10.021Dy G.W., Hsi R.S., Holt S.K., et al. National trends in secondary procedures following pediatric pyeloplasty. Journal of Urology. 2016; 195(4): 1209–14. https://doi.org/10.1016/j.juro.2015.11.010Moher D., Liberati A., Tetzlaff J., et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097. https://doi.org/10.1371/journal.pmed.1000097Moons K.G., Hooft L., Williams K., et al. Implementing systematic reviews of prognosis studies in Cochrane. Cochrane Database Syst Rev. 2018; 10: ED000129. https://doi.org/10.1002/14651858.ED000129Davis D.M., Strong G.H., Drake W.M. Intubated ureterotomy; experimental work and clinical results. J Urol. 1948; 59(5): 851–62. https://doi.org/10.1016/s0022-5347(17)69449-7