Challenging recurrent ureteropelvic junction obstructions: endoscopic procedures versus redo-pyeloplasty-a systematic review and meta-analysis.

introductionThe efficacy of endoscopic management of recurrent ureteropelvic junction obstruction (rUPJO) compared to redo pyeloplasty (RP) after primary intervention remains unclear. We performed a systematic review and meta-analysis (SR/MA) of comparative studies on endoscopic procedures (EP), specifically endopyelotomy or balloon dilation versus RP.

methodsWe conducted a PRISMA-compliant SR/MA registered in PROSPERO (CRD420251046758). We searched MEDLINE, Embase, Scopus, CINAHL, CENTRAL, and Web of Science without language or date restrictions (initial search in May 2025; updated in November 2025). Comparative studies evaluating EP versus RP for rUPJO were identified. Two reviewers performed screening, data extraction, and risk-of-bias assessment in duplicate. The outcomes assessed were treatment success (radiographic and/or functional patency, and/or symptom resolution) and perioperative complications. Subgroup analysis was conducted for adult vs pediatric patients. The Haenszel-Mantel Method with random-effects model meta-analyses generated pooled odds ratios (ORs) with 95% confidence intervals (CIs).

resultsA total of 1945 records were retrieved; ultimately, 12 studies with 549 patients (EP, n = 304; RP, n = 245) met the inclusion criteria. Definitions of success and follow-up duration varied across studies. Surgical approaches included open, laparoscopic, and robotic RP. EP techniques comprised endopyelotomy and balloon dilation, with selective use based on stricture length and vascular anatomy. Across all included comparative studies, RP demonstrated higher success than EP; the pooled effect size favored RP, with an OR of 6.32 (95% CI 3.25–12.32). Composite complication rates did not show a statistically significant difference between RP and EP 1.31 (95% CI 0.54–3.18). Secondary outcomes were heterogeneous but generally favored EP, including shorter operative time, shorter length of stay, and minimal blood loss. The heterogeneity among subgroups was low to moderate. The risk of bias assessment was determined to be high to serious, specifically due to confounders and retrospective designs, which introduced clinical selection bias and limited the overall quality of the evidence.

conclusionsFor rUPJO, RP was associated with higher odds of success than endoscopic management, without a demonstrable difference in complications. EP may be appropriate in carefully selected, favorable strictures; however, current comparative data support RP as the more reliable salvage option. Future work should prioritize standardized outcome definitions, prospective risk-adjusted comparisons, and transparent reporting of complication severity to refine patient selection and quantify trade-offs between approaches.