Laparoscopic Versus Open Pyeloplasty for Pelvicoureteric Junction Obstruction: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
ObjectivesTo compare outcomes of laparoscopic versus open pyeloplasty for the management of pelvicoureteric junction obstruction (PUJO) using a systematic review and meta-analysis.In September 2022, electronic database searches were conducted using the Cochrane Library, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, clinical trial registries, and relevant conferences to identify relevant abstracts and presentations.MethodsProspective randomized controlled trials comparing laparoscopic to open pyeloplasty for PUJO were included in the review. There were no restrictions on date or language. All populations were included. The authors performed data extraction and risk of bias assessment using the risk of bias tool. Meta-analysis was performed using RevMan software.ResultsSix prospective randomized controlled trials involving 335 participants were included in the analysis. Six studies included data on the failure rate, with a slight favouring of open pyeloplasty compared to laparoscopic pyeloplasty, although this was not statistically significant (odds ratio [OR], 1.39; 95% confidence interval [CI] 0.50 to 3.83).Five studies compared operative time, with open pyeloplasty found to have shorter times across all studies (mean difference [MD], 54.97 minutes; 95% CI 47.08 to 62.85).Based on 5 studies, laparoscopic pyeloplasty has a shorter hospital stay (MD, 4.12 days; 95% CI 3.64 to 4.59).Two studies compared postoperative analgesia requirements, showing a lower diclofenac requirement in the laparoscopic group (MD, 330.08 mg; 95% CI 298.05 to 362.11 mg).One study compared blood loss intraoperatively and found no significant difference between the groups (MD, 8.52 mL; 95% CI -2.49 to 19.53).Based on 4 studies, laparoscopic pyeloplasty may result in slightly higher complication rates postoperatively (OR, 1.49; 95% CI 0.53 to 4.18); however, there was no statistically significant difference.No subgroup analyses were conducted.ConclusionsLimited, low-quality evidence from small-scale trials suggests that laparoscopic pyeloplasty has improved outcomes in terms of shorter hospital stays and reduced postoperative pain compared to open pyeloplasty. Open pyeloplasty, on the other hand, had a shorter operative time. Failure rate, complication rate, and blood loss were comparable between the 2 approaches.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.030 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.027 | 0.040 |
| Bibliometrics | 0.009 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".