Predictors of Complications after Pediatric Pyeloplasty: A Retrospective Cohort Study and Meta-Analysis

Objective: Pyeloplasty is the gold standard procedure for treating ureteropelvic junction obstruction (UPJO), but the occurrence of postoperative complications is a major challenge. This study aimed to identify the predictors of postpyeloplasty complications, which are not well characterized in contemporary literature. Study Design: We retrospectively analyzed data of children who underwent pyeloplasty in our hospital from January 2011 to August 2022, with a minimum follow-up of 1 year. Furthermore, a systematic review and meta-analysis of studies published from 2000 to 2023 was performed to identify predictors of complications. Results: In cohort studies ( n = 555), preoperative urinary tract infection (pre-UTI) (odds ratio [OR] = 5.65, 95% confidence interval [CI]: 2.96–10.78, p < 0.001), Double J-stent duration (OR = 1.005, 95% CI: 1.001–1.008, p = 0.005), renal cortical thickness (OR = 0.181, 95% CI: 0.071–0.461, p < 0.001), and collection system separation (OR = 1.170, 95% CI: 1.017–1.347, p = 0.028) were associated with total postoperative complications. Pre-UTI (OR = 4.87, 95% CI: 1.98–11.98, p = 0.001), Double J-stent duration (OR = 1.005, 95% CI: 1.001–1.009, p = 0.019), preoperative renal cortical thickness (OR = 0.197, 95% CI: 0.042–0.928, p = 0.040), and duration of operation (OR = 1.013, 95% CI: 1.003–1.022, p = 0.008) were associated with recurrence. Pre-UTI (OR = 5.33, 95% CI: 2.73–10.38, p < 0.001) and preoperative renal cortical thickness (OR = 0.351, 95% CI: 0.124–0.990, p = 0.048) were predictors of postoperative UTI. In the meta-analysis, sex ( I 2 = 0%, relative risk [RR] = 1.19, 95% CI: 1.01–1.40, p = 0.04), operation methods, and split renal function ( I 2 = 50%, RR = 0.76, 95% CI: 0.59–0.96, p = 0.02) were identified as predictors of postoperative complications. Conclusions: We identified the predictors of postpyeloplasty complications. Early identification and treatment can help us reduce the incidence of complications.