A comparative analysis of retroperitoneal small-incision open pyeloplasty and laparoscopic pyeloplasty for infantile hydronephrosis.

backgroundWith the development of minimally invasive surgery, laparoscopic pyeloplasty has become the mainstream surgery for ureteropelvic junction obstruction(UPJO), while open surgery is used less frequently. However, in regions where endoscopic techniques are not yet well-developed or in very young infants, open pyeloplasty still plays a significant role. This study aims to evaluate the clinical efficacy and safety of the retroperitoneal small-incision open pyeloplasty in infants by comparing it with laparoscopic pyeloplasty.

methodsThis retrospective cohort enrolled 117 infants diagnosed with UPJO and underwent pyeloplasty at the Department of Urology of Tianjin Children's Hospital between December 2019 and June 2025. These patients were divided into two groups according to the operation method. Open pyeloplasty (OP) and laparoscopic pyeloplasty (LP) were performed on 47 and 70 of these 117 patients, respectively. The clinical characteristics and follow-up data of these cohorts were retrospectively collected and analyzed. Statistical analyses were performed using GraphPad Prism 10.6.0. Normality of continuous variables was assessed by the Shapiro-Wilk test. Comparisons between the laparoscopic and open pyeloplasty groups were performed using the unpaired Student's t-test (for normally distributed data) or the Mann-Whitney U test (for non-normally distributed data). Categorical variables were analyzed using the chi-square test, with Fisher's exact test applied when expected cell counts were less than 5. A two-tailed p-value < 0.05 was considered statistically significant.

resultsA total of 117 pediatric patients were included in the study, with 47 infants in the OP group, and 70 in the LP group. The operative time (93.79 ± 22.38 vs. 155.13 ± 33.07 min, P < 0.0001), time of postoperative meal intake(1.23 ± 0.57 vs. 2.17 ± 0.79 day, P < 0.0001), and hospitalization expenses (33041 ± 2394 vs. 53645 ± 1968 yuan, P < 0.0001) were significantly shorter in OP group than in LP group, whereas the duration of postoperative hospital stay(19.40 ± 4.45 vs. 12.68 ± 3.63 day, P < 0.0001), the postoperative transfusion rate ( 6 vs. 0, P = 0.005) were significantly lower in the LP group than in the OP group. No significant differences were observed between the two groups with respect to age, side, SFU grade, follow-up duration, rate of diarrhea, or reintervention rate. The ureteral stent was removed at the mean of 12.98 ± 3.86 postoperative days, and the nephrostomy tube at 17.75 ± 13.48 postoperative days. In contrast, the peritoneal cavity drainage tube was removed at 3.41 ± 2.14 postoperative days, while the double-J tube was removed via ureteroscopy at 70.68 ± 16.81 postoperative days( P < 0.0001 ). Postoperative urine cultures were positive in 38 patients of the LP group compared to 7 cases in the OP group. Furthermore, 8 patients in LP group were diagnosed with acute pyelonephritis and required hospitalization for treatment. Both surgical procedures significantly reduced postoperative APD (all P < 0.001). The OP group presented a higher preoperative baseline APD than the LP group (P = 0.010). Nevertheless, no significant intergroup difference was observed in postoperative APD levels (P = 0.593). Additionally, the difference in APD reduction between the two groups was marginally non-significant (P = 0.055).

conclusionsAt our center, retroperitoneal small-incision open pyeloplasty required shorter operative times than LP, avoiding DJ stent placement and potentially reducing the risk of postoperative urinary tract infections. While both procedures are effective for UPJO in selected infants, neither can be universally regarded as superior, and treatment decisions should be individualized based on patient characteristics.