Outcomes of non‐reduction vs reduction pyeloplasty: a systematic review and meta‐analysis
Bibliographic record
Abstract
OBJECTIVE: To compare the surgical outcomes between non-reduction and reduction pyeloplasty in the management of pelvi-ureteric junction obstruction among patients such as postoperative functional outcomes, complication rate, and failure rate through a meta-analysis of comparative studies. PATIENTS AND METHODS: Electronic databases including PubMed, EMBASE, Scopus, and Cochrane Library, including the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched to identify published literature comparing reduction and non-reduction pyeloplasty in adult and paediatric patients. Data on anteroposterior pelvic diameter (APPD), differential renal function (DRF), and complications were extracted. Data synthesis and statistical analysis were done using ReviewManager. Random-effects model and standard mean difference (SMD) were used for calculation of all effect estimates with 95% confidence intervals (CIs) for extrapolation. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO:CRD42021288645). RESULTS: Five studies were selected for analysis, encompassing 177 renal units, of which 88 cases were reduction pyeloplasty and 89 cases were non-reduction pyeloplasty. Continuous variables were presented as SMDs with their 95% CIs. Our overall pooled effect estimates showed a statistically significant difference favouring reduction pyeloplasty in terms of postoperative APPD (SMD 1.77, 95% CI 0.43-3.10) and change in APPD (SMD 1.21, 95% CI 0.07-2.36). No statistically significant difference was observed for postoperative DRF (SMD 0.27, 95% CI -0.10 to 0.64) and change in DRF (SMD 0.68, 95% CI -0.39 to 1.74). Subgroup analyses revealed no statistically significant difference for all functional outcomes. Analysis of both groups revealed no significant difference in terms of postoperative complication rate (relative risk [RR] 0.91, 95% CI 0.38-2.16) and failure rate (RR 1.50, 95% CI 0.28-8.04). CONCLUSION: The evidence suggests that non-reduction pyeloplasty results in comparable postoperative DRF and change in DRF. Although reduction pyeloplasty results in superior APPD and change in APPD compared to non-reduction pyeloplasty, these findings may be clinically negligible. Complication and failure rates between the two groups are comparable.
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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 | 0.015 | 0.031 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.024 | 0.048 |
| Bibliometrics | 0.006 | 0.006 |
| 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".