COMPARISON OF TREATMENT METHODS FOR URETEROPELVIC JUNCTION OBSTRUCTION AND DRAINAGE METHODS IN CHILDREN

Abstract

Congenital hydronephrosis caused by ureteropelvic junction obstruction (UPJO) remains one of the main causes of chronic kidney disease in childhood. Laparoscopic pyeloplasty has become the standard of treatment; however, in young children its performance is associated with technical difficulties. In addition, traditional retrograde stenting and subsequent endoscopic stent removal require additional anesthesia, which increases the anesthetic burden on the child. The aim of the study was to compare the clinical efficacy of various surgical treatment methods for UPJO and postoperative urinary tract drainage techniques in children. Materials and methods: a retrospective comparative cohort study of surgical treatment outcomes of 111 children with UPJO over the period 2024–2026 was conducted. The primary endpoints were the incidence of postoperative complications and the length of postoperative hospital stay. The control group included 56 patients (open lumbotomy), while the main group included 55 patients (laparoscopic pyeloplasty). In the main group, the following were used: age-adapted port placement, minimal dissection technique, continuous running anastomosis, antegrade stenting, and a patented method of anesthesia-free stent removal using a Foley catheter loop. Statistical processing was performed using Student's t-test, Mann-Whitney U-test, and Pearson's χ2 test. Results: the mean duration of laparoscopic surgery was 105.2±14.6 min compared to 68.5±8.4 min for open surgery (p<0.001). However, the laparoscopic approach provided a 3-fold reduction in intraoperative blood loss (6.4±2.5 vs 19.2±4.8 mL; p<0.001) and a significant reduction in postoperative hospital stay (7.1±1.2 vs 13.4±2.1 days; p<0.001). The incidence of early complications according to the Clavien-Dindo classification in the laparoscopic group was 7.2% (4/55) versus 19.6% (11/56) in the control group; the differences were not statistically significant (p=0.056), although a marked trend towards a decrease in complications was observed in the laparoscopic group. The use of anesthesia-free stent removal completely eliminated the need for repeat intubation. Conclusion: laparoscopic pyeloplasty combined with antegrade stenting and anesthesia-free drainage removal reduces surgical aggression, minimizes anesthetic risks, and accelerates rehabilitation of children with UPJO compared to traditional open surgery.