The optimal stent-strategy in paediatric pyeloplasty: a systematic review and network meta-analysis.

OBJECTIVES: To compare internal JJ stenting, external transanastomotic stenting and stentless repair after Anderson-Hynes pyeloplasty in children. PATIENTS AND METHODS: A systematic review and network meta-analysis of children with pelvi-ureteric junction (PUJ) obstruction undergoing Anderson-Hynes pyeloplasty. The MEDLINE, EMBASE, Cochrane Library and Web of Science databases were searched from inception to February 2025. Randomised and non-randomised comparative studies were included. Network meta-analysis compared JJ stenting, external stenting and no stenting. Risk of bias and certainty of evidence were assessed. RESULTS: A total of 26 studies including 3298 children were analysed. Overall complications did not differ significantly between strategies and operative success was high. External stenting was associated with lower odds of major complications compared with no stenting (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.33-0.93). The JJ and external stenting were associated with lower odds of major urine leakage or urinoma compared with stentless repair (OR 0.20, 95% CI 0.07-0.60; and OR 0.20, 95% CI 0.07-0.61, respectively). Minor complications were similar between strategies, as were stent-related complications between JJ and external stenting. JJ stenting was associated with higher odds of urinary tract infection or pyelonephritis compared with no stenting, but with shorter hospital stay compared with external stenting. Certainty of evidence was low or very low for most outcomes. CONCLUSION: Paediatric pyeloplasty achieves high success rates regardless of drainage strategy. Stented approaches may reduce major leakage-related complications compared with stentless repair, while JJ stents may increase infectious complications. Drainage strategy should remain individualised.