Multiple surgical treatment options are available for the treatment of ureteropelvic junction obstruction (UPJO). The aim of this study is to compare the most frequently used technics in a comprehensive network approach. A systematic literature search of the EMBASE, MEDLINE and COCHRANE libraries was conducted in January 2018. Publications were included that evaluated at least two of the following surgical techniques: open pyeloplasty (OP), endopyelotomy (EP), laparoscopic (LP) and robot assisted pyeloplasty (RP). Main outcomes were operative success, complications, urinary leakage, re-operation, transfusion rate, operating time, and length of stay. Network meta-analyses with random effects models simultaneously assessed effectiveness of all surgical techniques. A total of 26 studies including 3143 patients were analyzed. Compared with RP, EP and LP showed lower operative success rates (EP: OR = 0.09, 95%CI:0.05–0.19; p < 0.001; LP: OR = 0.51, 95%CI:0.31–0.84; p = 0.008). Compared with OP, LP and RP had lower risk for complications (LP: OR = 0.62; 95%CI:0.41–0.95; p = 0.027; RP: OR = 0.41; 95%CI:0.22–0.79; p = 0.007). Compared with RP, no significant differences were detected for urinary leakage or re-operation, transfusion rates. Compared with EP, RP yielded longer operating time (mean = 102.87 min, 95%CI:41.79 min–163.95 min, p = < 0.001). Further significant differences in operating times were detected when comparing LP to EP (mean = 115.13 min, 95%CI:65.63 min–164.63 min, p = < 0.001) and OP to EP (mean = 91.96 min, 95%CI:32.33 min–151.58 min, p = 0.003). Multiple surgical techniques are available for treatment of UPJO. RP has the highest rates of operative success and as well as LP lower complication rates than OP. Although surgical outcomes are worse for EP, its operating time is shorter than OP, RP, and LP. Surgeons should consider these findings when selecting the optimal treatment method for individual patients.

中文翻译：

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输尿管盆腔连接梗阻的外科手术方法-系统评价和网络Meta分析

多种外科治疗方法可用于治疗输尿管盆腔连接梗阻（UPJO）。这项研究的目的是在综合网络方法中比较最常用的技术。2018年1月对EMBASE，MEDLINE和COCHRANE库进行了系统的文献检索。包括的出版物对至少以下两种手术技术进行了评估：开放式肾盂成形术（OP），内窥镜切开术（EP），腹腔镜（LP）和机器人辅助肾盂成形术（RP）。主要结局为手术成功，并发症，尿漏，再次手术，输血率，手术时间和住院时间。具有随机效应模型的网络荟萃分析同时评估了所有手术技术的有效性。共分析了26项研究，包括3143例患者。与RP相比，EP和LP手术成功率较低（EP：OR = 0.09，95％CI：0.05-0.19； p <0.001； LP：OR = 0.51，95％CI：0.31-0.84； p = 0.008）。与OP相比，LP和RP发生并发症的风险更低（LP：OR = 0.62； 95％CI：0.41-0.95； p = 0.027； RP：OR = 0.41； 95％CI：0.22-0.79； p = 0.007）。与RP相比，尿漏或再次手术，输血率没有显着差异。与EP相比，RP产生更长的操作时间（平均值= 102.87分钟，95％CI：41.79分钟– 163.95分钟，p = <0.001）。将LP与EP（平均值= 115.13分钟，95％CI：65.63分钟–164.63分钟，p = <0.001）进行比较，将OP与EP（平均值= 91.96分钟，95％CI：32.33分钟）进行比较，发现在操作时间上存在进一步的显着差异–151.58分钟，p = 0.003）。多种手术技术可用于治疗UPJO。RP的手术成功率最高，而LP的并发症发生率低于OP。尽管EP的手术结局较差，但其手术时间比OP，RP和LP短。外科医生在为个别患者选择最佳治疗方法时应考虑这些发现。