upload_7btavrmymvj76db7vxb6vy4xrx.pdf

68

J Gandhara Med Dent Sci

October - December 2026

How to cite this article

:

COMPARISON OF FUNCTIONAL AND MORPHOLOGICAL OUTCOMES OF OPEN VERSUS

LAPAROSCOPIC PYELOPLASTY IN INFANTS WITH URETEROPELVIC JUNCTION

OBSTRUCTION

Khan Y, Ahmad T, Ali M,

Muhammad A, Ali A, Shah AB.

Comparison

of Functional and

Morphological Outcomes of open

Versus Laparoscopic Pyeloplasty in

Infants with Ureteropelvic Junction

Obstruction. J Gandhara Med Dent

Sci. 2026;13(4):68-73.

Date of Submission:

03-03-2026

Date Revised:

17-09-2026

Date Acceptance:

17-09-2026

1

Post Graduate Resident, Department of

Urology, Khyber Teaching Hospital,

Peshawar

Correspondence

2

Tariq Ahmad, Associate Professor

Department of Urology, Khyber

Teaching Hospital, Peshawar

+92-345-9228080

drtariqurologistikd@gmail.com

ABSTRACT

OBJECTIVES

The

aim

of

the

study

was

to

compare

functional,

morphological,

perioperative,

and

short-term

surgical

outcomes

of

open

and

laparoscopic

pyeloplasty in infants with unilateral ureteropelvic junction obstruction.

METHODOLOGY

This

prospective

quasi-experimental

study

enrolled

116

infants

aged

12

months

or

younger

at Khyber

Teaching

Hospital,

Peshawar, between

June

and

November

2025,

with

six-month

postoperative

follow-up.

Fifty-eight

infants

underwent

open

Anderson-Hynes

pyeloplasty

and

58

underwent

transperitoneal

laparoscopic pyeloplasty;

allocation

was

based

on

surgeon

expertise

and

parental

preference.

Estimated

glomerular

ﬁltration

rate

(eGFR),

renal

pelvic

anteroposterior

diameter,

and

renal

parenchymal

thickness

were

assessed

before

surgery

and

at

six

months.

Operative

time,

hospital stay, complications, and surgical success were also compared.

RESULTS

Baseline

characteristics

and

preoperative

eGFR

were

comparable

between

groups.

At

six

months,

mean

eGFR

increased

by

5.3

mL/min/1.73 m²

after

open

pyeloplasty

and

6.1

mL/min/1.73

m²

after

laparoscopic

pyeloplasty

(p=0.016).

Reduction

in

anteroposterior

diameter

was

greater

after

laparoscopy (18.4±3.1 vs 15.8±2.9 mm; p<0.0001), as was improvement in

parenchymal

thickness

(4.0±0.7

vs

3.0±0.7

mm;

p=0.001).

Laparoscopy

required

longer

operative

time

(165±25

vs

90±12

minutes;

p=0.001)

but

shorter hospitalisation (5.0±1.5 vs 6.5±2.0 days; p=0.002). Surgical success

was similar (94.8% vs 93.1%; p=0.65), with low complication rates.

CONCLUSION

Both

approaches

produced

high

success

and

acceptable

morbidity.

Laparoscopy

showed

modestly

greater

functional

and

morphological

improvement

and

shorter

hospitalisation,

but

the

non-randomised

design

limits

causal

interpretation.

eGFR

was

calculated

with

age-appropriate

creatinine-based

equations,

ultrasound

was

interpreted

by

a

radiologist

blinded to surgical approach, and complications were classiﬁed according to

the Clavien-Dindo system. Longer follow-up is required to determine whether

these diﬀerences persist in this infant population.

KEYWORDS:

Ureteropelvic

Junction

Obstruction,

Pyeloplasty,

Laparoscopy; Infant, Estimated Glomerular Filtration Rate, Hydronephrosis

INTRODUCTION

Congenital

ureteropelvic

junction

obstruction

(UPJO)

results from impaired drainage of urine from the renal

pelvis into the proximal ureter and is one of the most

frequent

causes

of

antenatal

and

neonatal

hydronephrosis.

The

obstruction

may

be

intrinsic

narrowing,

abnormal

smooth-muscle

development,

high

ureteral

insertion,

or

extrinsic

compression by crossing vessels.

1

The clinical course is

variable: some infants remain stable under surveillance,

whereas

clinically

signiﬁcant

obstruction

may

lead

to

progressive hydronephrosis, recurrent urinary infection,

pain,

or

deterioration

of

renal

function.

Ultrasonography

is

the

principal

anatomical

investigation,

while

technetium-99m

mercaptoacetyltriglycine

diuretic

renography

provides

information on drainage and diﬀerential renal function

when

obstruction

is

suspected.

2

The

Anderson-Hynes

dismembered

pyeloplasty

remains

the

standard

reconstructive

operation

for

UPJO.

Open

pyeloplasty

has

historically

achieved

excellent

success

rates

and

remains particularly relevant in centres where advanced

minimally

invasive

technology

is

limited.

During

the

last

two

decades,

laparoscopic

and

robot-assisted

approaches

have

increasingly

been

adopted

because

they

oﬀer

smaller

incisions

and

the

potential

for

reduced

postoperative

discomfort

and

shorter

ORIGINAL ARTICLE

http://doi.org/10.37762/jgmds.13-4.879

Tariq Ahmad

Younas Khan

1

,

2

, Murad Ali

1

,

Asghar Ali

1

,

Adil Muhammad ,

Abdul Basit Shah

1

69

J Gandhara Med Dent Sci

October - December 2026

hospitalisation.

3,4

Their

use

in

infants

is

technically

more

demanding

than

in

older

children

because

of

restricted

working

space,

small-calibre

structures,

and

the

need

for

precise

intracorporeal

suturing.

Contemporary

evidence

suggests

that

minimally

invasive

pyeloplasty

can

achieve

success

and

complication

rates

comparable

with

open

surgery

in

appropriately

selected

infants.

Meta-analyses

of

infant

populations

have

generally

found

longer

operative

duration with minimally invasive techniques but shorter

hospital

stay,

with

no

consistent

disadvantage

in

success, reintervention or overall complication rates.

3,4,5

Multi-institutional series also support the feasibility of

laparoscopic and robotic approaches in infants once the

surgical

learning

curve

has

been

overcome.

6

Robotic

systems

may

improve

dexterity

and

suturing

ergonomics, but cost, access

to equipment, instrument

size, and specialised training remain major constraints

in many health systems.

Recent infant-speciﬁc studies

have

extended

these

observations

to

neonates

and

infants

younger

than

six

months.

8,9

Most

available

comparisons

are

retrospective,

use

heterogeneous

definitions

of

success,

and

focus

mainly

on

operative

time,

hospitalisation

and

revision

rates.

Functional

recovery after relief of obstruction is more diﬃcult to

assess.

Diuretic

renography

provides

diﬀerential

renal

function,

but

creatinine-based

estimated

glomerular

filtration

rate

(eGFR)

is

also

commonly

used

to

describe

overall

renal

function.

The

accuracy

of

creatinine-based

eGFR

varies

with

age,

body

size,

muscle mass and assay calibration, which is particularly

important

in

early

infancy.

10

Consequently,

small

between-group

diﬀerences

in

eGFR

should

be

interpreted

cautiously

and

in

conjunction

with

morphological

and

drainage

outcomes.

Renal

pelvic

anteroposterior

diameter

(APD)

and

parenchymal

thickness

provide

additional

morphological

indicators

of postoperative improvement. Successful correction of

UPJO

is

generally

accompanied

by

decreasing

hydronephrosis and gradual recovery or preservation of

renal

parenchyma,

although

the

extent

and

timing

of

improvement

vary

according

to

baseline

severity

and

age.

11,12,13,14,15,16

Evaluating

functional

and

morphological

outcomes

together

may

therefore

provide a more complete picture than surgical success

alone.

In

Pakistan

and

similar

resource-constrained

settings,

open

pyeloplasty

remains

widely

practised

while laparoscopic expertise is expanding. Comparative

prospective evidence in infants is limited, and local data

are

useful

for

counselling

families,

planning

services

and

defining

which

outcomes

justify

the

technical

demands

of

minimally

invasive

surgery.

The

present

study

therefore

compared

open

and

laparoscopic

pyeloplasty in infants with unilateral UPJO, focusing on

change

in

eGFR,

improvement

in

APD

and

renal

parenchymal thickness, perioperative recovery, surgical

success, and postoperative complications.

parental

preference.

Both

treatment

groups

were

managed

during

the

same

study

period,

allowing

contemporaneous

comparison.

The

sample

size

was

calculated

for

comparison

of

two

means

using

an

expected

diﬀerence

of

5

mL/min/1.73

m²

in

postoperative eGFR, an assumed standard deviation of

10 mL/min/1.73 m², a two-sided alpha of 0.05, and 80%

power. The ﬁnal sample comprised 116 infants, with 58

in

the

open-pyeloplasty

group

and

58

in

the

laparoscopic group. Infants aged 12 months or younger

with

unilateral

primary

UPJO

conﬁrmed

by

ultrasonography and diuretic renography and judged to

require

surgical

correction

were

eligible.

Exclusion

criteria were bilateral obstruction, vesicoureteric reﬂux,

duplex

collecting

system,

renal

dysplasia,

could materially aﬀect perioperative or renal outcomes.

Preoperative

assessment

included

clinical

evaluation,

ultrasonography,

serum

creatinine

measurement

and

height

measurement.

For

infants

aged

four

weeks

or

younger,

eGFR

was

calculated

using

the

protocol-

specified

neonatal

creatinine-based

equation:

0.313

×

height (cm)/serum creatinine (mg/dL). In infants older

than

four

weeks,

the

revised

Schwartz

equation

was

used:

eGFR

=

0.413

×

height

(cm)/serum

creatinine

(mg/dL). Serum creatinine measurement was performed

using

an

assay

traceable

to

isotope-dilution

mass

spectrometry. The same age-appropriate approach was

used

at

follow-up

to

maintain

internal

consistency.

Open

dismembered

pyeloplasty

was

performed

using

the Anderson-Hynes technique through a ﬂank incision.

After

mobilisation

of

the

renal

pelvis,

the

obstructed

ureteropelvic segment was excised, and the ureter was

spatulated.

Pelviureteric

anastomosis

was

completed

with

interrupted

6-0

polyglactin

sutures

over

a

4.5-F

double-J

stent.

A

perirenal

drain

was

placed

and

removed

when

output

became

minimal.

Laparoscopic

pyeloplasty

was

performed

through

a

transperitoneal

three-port approach. A 5-mm umbilical camera port and

two

3-mm

working

ports

were

inserted

under

direct

METHODOLOGY

This

prospective

quasi-experimental

study

was

conducted

in

the

Department

of

Urology,

Khyber

Teaching Hospital, Peshawar, Pakistan. Enrollment and

surgery took place between June and November 2025,

and each participant was followed for six months after

the

procedure.

The

institutional

ethics

committee

approved(Ref No. 87/DME/KMC, Dated: 23-01-2025)

the

study

protocol,

and

written

informed

consent

was

obtained

from

the

parent

or

legal

guardian

of

each

infant.

Because

allocation

was

not

randomised,

treatment

selection

reﬂected

surgeon

expertise

and

Comparison of Functional and Morphological Outcomes of Open Versus

70

J Gandhara Med Dent Sci

October - December 2026

vision. After mobilisation of the colon, the renal pelvis

and

ureteropelvic

junction

were

exposed,

the

stenotic

segment was excised, and a dismembered pelviureteric

anastomosis

was

completed

using

6-0

polyglactin

sutures.

A double-J stent was inserted antegradely. An

external

drain

was

placed

and

was

generally

removed

on the second or third postoperative day. Postoperative

management

in

both

groups

included

analgesia,

early

feeding as tolerated, and mobilisation appropriate to age

and clinical recovery. The primary outcome was change

in

eGFR

from

baseline

to

six

months.

Secondary

outcomes included change in renal pelvic APD, change

in renal parenchymal thickness, operative time, length

of

hospital

stay,

surgical

success,

and

postoperative

complications.

Follow-up

ultrasonography

was

performed using the same anatomical variables, and the

radiologist

interpreting

ultrasound

was

blinded

to

the

surgical

approach.

Surgical

success

was

deﬁned

as

resolution

or

improvement

of

clinical

symptoms,

improved

drainage

on

postoperative

renography,

and

stable

or

improved

renal

function.

Postoperative

complications were classiﬁed according to the Clavien-

Dindo

system,

with

grades

I-II

considered

minor

complications. Statistical analysis was performed using

Python

version

3.13

and

SciPy

version

1.11.

A

two-

sided

p-value

<0.05

was

considered

statistically

signiﬁcant.

RESULTS

The

study

included

116

infants,

with

58

undergoing

open

pyeloplasty

and

58

undergoing

laparoscopic

pyeloplasty.

The

mean

age

of

the

cohort

was

approximately three months. Baseline demographic and

renal characteristics were broadly comparable between

groups.

Mean

age

was

3.35±0.73

months

in

the

open

group and 3.11±0.84 months in the laparoscopic group

(p=0.12).

Preoperative

eGFR

was

34.37±4.20

and

35.30±4.14

mL/min/1.73

m²,

respectively

(p=0.22).

Baseline APD and renal parenchymal thickness also did

not

diﬀer

signiﬁcantly

(Table

1).

Operative

time

was

substantially longer with laparoscopy (165±25 minutes)

than with open pyeloplasty (90±12 minutes; p=0.001).

In contrast, hospital stay was shorter after laparoscopic

surgery (5.0±1.5 days) than after open surgery (6.5±2.0

days;

p=0.002).

No

laparoscopic

procedure

required

conversion

to

open

surgery.

Minor

postoperative

complications

occurred

in

6/58

(10.3%)

infants

after

open

surgery

and

5/58

(8.6%)

after

laparoscopy

(Table2).

At

six

months,

eGFR

increased

in

both

groups.

Mean

postoperative

eGFR

was

39.63

mL/min/1.73

m²

after

open

pyeloplasty

and

41.40

mL/min/1.73

m²

after

laparoscopic

pyeloplasty.

The

mean

change

was

+5.3

mL/min/1.73

m²

in

the

open

group

and

+6.1

mL/min/1.73

m²

in

the

laparoscopic

group,

with

a

statistically

signiﬁcant

between-group

diﬀerence

(p=0.016).

The

source

analysis

reported

a

moderate

eﬀect

size

for

the

eGFR

change

(Cohen's

d=0.40),

suggesting

that

the

statistical

diﬀerence

was

not

large

in

magnitude.

Morphological

recovery

was

also observed in both groups. Reduction in renal pelvic

APD

was

greater after laparoscopic surgery (18.4±3.1

mm) than after open surgery (15.8±2.9 mm; p<0.0001).

Renal parenchymal thickness increased by 4.0±0.7 mm

after

laparoscopy

compared

with

3.0±0.7

mm

after

open

surgery

(p=0.001).

The

source

analysis

reported

large

eﬀect

sizes

for

these

morphological

changes.

Surgical success was high and statistically comparable

between groups: 93.1% after open surgery and 94.8%

after laparoscopy (p=0.65).

Overall complication rates

remained

low

and

were

similar

(Table

3).

Taken

together,

the

results

indicate

that

both

approaches

achieved favourable six-month outcomes. Laparoscopy

was

associated

with

longer

operating

time

but

shorter

hospitalisation, slightly greater improvement in eGFR,

and

larger

ultrasound-measured

morphological

improvement.

Because

treatment

allocation

was

not

random,

these

diﬀerences

should

be

interpreted

as

comparative associations rather than deﬁnitive evidence

of superiority.

Table 1: Baseline Characteristics of the Study Population

Variable

Open

pyeloplasty

(n = 58)

Laparoscopic

pyeloplasty

(n = 58)

p-value

Age (months), mean

± SD

3.35 ± 0.73

3.11 ± 0.84

0.12

Weight (kg), mean ±

SD

5.66 ± 1.12

5.25 ± 1.05

0.08

Preoperative eGFR

(mL/min/1.73 m²),

mean ± SD

34.37 ± 4.20

35.30 ± 4.14

0.22

Preoperative APD

(mm), mean ± SD

32.42 ± 6.25

30.24 ± 5.00

0.07

Preoperative

parenchymal

thickness (mm),

mean ± SD

2.59 ± 1.07

2.39 ± 0.72

0.18

Table 2: Perioperative Outcomes According to Surgical

Approach

Outcome

Open

pyeloplasty

Laparoscopic

pyeloplasty

p-value

Operative time

(minutes), mean ± SD

90 ± 12

165 ± 25

0.001

Length of hospital

stay (days), mean ±

SD

6.5 ± 2.0

5.0 ± 1.5

0.002

Minor postoperative

complications, n

(%)

6 (10.3)

5

(8.6)

—

Conversion to open

surgery, n

Not applicable

0

—

Comparison of Functional and Morphological Outcomes of Open Versus

71

J Gandhara Med Dent Sci

October - December 2026

Table 3:

Functional,

Morphological,

and

Surgical

Outcomes

at

Six Months

Outcome

Laparoscopic

pyeloplasty

p-value

Postoperative eGFR

(mL/min/1.73 m²)

41.40

—

Change in eGFR

(mL/min/1.73 m²)

+6.1

0.016

Reduction in APD

(mm), mean ± SD

18.4 ± 3.1

<0.0001

Increase in parenchymal

thickness (mm), mean ± SD

4.0 ± 0.7

0.001

Surgical success (%)

94.8

0.65

Complication rate (%)

8.6

—

Open

pyeloplasty

39.63

+5.3

15.8 ± 2.9

3.0 ± 0.7

93.1

10.3

DISCUSSION

This

prospective

quasi-experimental

study

compared

open

and

laparoscopic

pyeloplasty

in

infants

with

unilateral UPJO under routine clinical conditions. Both

procedures

achieved

high

surgical

success

and

low

complication

rates.

Laparoscopic

pyeloplasty

required

considerably longer operating time but was associated

with

shorter

hospital

stay

and

statistically

greater

improvement

in

eGFR,

APD

and

renal

parenchymal

thickness

at

six

months.

The

absolute

functional

diﬀerence

was

modest,

and

the

non-randomised

allocation

means

that

the

ﬁndings

should

not

be

interpreted

as

proof

of

causal

superiority.

The

perioperative

pattern

observed

in

this

cohort

is

consistent

with

contemporary

evidence.

A

systematic

review

and

meta-analysis

of

3,494

infants

found

that

minimally

invasive

pyeloplasty

was

associated

with

longer operative time and shorter hospitalisation, while

success,

complication

and

reintervention

rates

were

comparable

with

open

surgery.

5

The

longer

operative

duration

reﬂects

the

technical

complexity

of

laparoscopic

reconstruction

in

a

small

abdominal

working

space,

particularly

intracorporeal

suturing

of

delicate infant tissue. Infant-speciﬁc clinical series have

reported

similar

operative-time

diﬀerences

without

clear

compromise

in

surgical

success.

8,11

Shorter

postoperative

hospitalisation

after

laparoscopy

is

clinically relevant, especially in high-volume paediatric

surgical

services.

Smaller

incisions,

reduced

wound

trauma,

earlier

feeding

and

lower

analgesic

requirements may facilitate discharge. However, length

of

stay

is

also

inﬂuenced

by

institutional

discharge

criteria,

parental conﬁdence,

travel

distance,

stent and

drain protocols, and bed availability. For this reason, a

difference

of

approximately

1.5

days

in

the

present

study

should

be

interpreted

as

a

service

and

recovery

outcome

rather

than

a

direct

measure

of

technical

success.

Both

procedures

produced

improvement

in

renal

function

after

relief

of

obstruction.

The

laparoscopic group demonstrated a statistically

greater

mean

increase

in

eGFR,

but

the

between-group

diﬀerence in change was less than 1 mL/min/1.73 m².

Such a diﬀerence may reach statistical signiﬁcance in a

balanced sample yet have uncertain individual clinical

importance. Creatinine-based eGFR in early infancy is

inﬂuenced by rapid changes in body size, muscle mass,

renal

maturation

and

serum

creatinine

kinetics.

Measured

clearance

was

not

available,

and

eGFR

should

therefore

be

interpreted

as

a

supportive

functional

marker

rather

than

a

direct

measure

of

diﬀerential

function

of

the

operated

kidney.

10

The

magnitude

of

postoperative

morphological

improvement was more pronounced. Reduction in APD

and

increase

in

renal

parenchymal

thickness

were

greater

after

laparoscopy

in

the

submitted

dataset.

Studies of newborns and young infants have similarly

documented

substantial

postoperative

reduction

in

hydronephrosis

and

progressive

increase

in

renal

parenchymal

thickness

after

successful

pyeloplasty.

13

Nevertheless,

these

ultrasound

changes

may

be

inﬂuenced

by

baseline

anatomy,

hydration,

bladder

filling, measurement technique and timing of follow-up.

Blinded

radiological

assessment

in

the

present

study

strengthens

the

comparison,

but

standardisation

of

ultrasound

acquisition

is

still

essential

when

interpreting

relatively

small

absolute

diﬀerences.

The

mean age at surgery was approximately three months.

Early correction of clinically signiﬁcant obstruction has

been

proposed

as

a

means

of

preserving

recoverable

renal

tissue,

and

some

infant

studies

have

reported

greater

improvement

in

hydronephrosis

or

split

renal

function

when

pyeloplasty

is

performed

earlier.

14,16

Other

reviews

have

found

that

baseline

diﬀerential

renal function and severity of obstruction may be more

consistent

predictors

than

age

alone.

15

The

present

study

was

not

designed

to

compare

diﬀerent

ages

at

intervention,

so

favourable

recovery

cannot

be

attributed

solely

to

early

surgery.

Complication

rates

were low in both groups, and no laparoscopic procedure

required

conversion

to

open

surgery.

This

ﬁnding

supports

the

technical

feasibility

of

laparoscopic

pyeloplasty

in

selected

infants

when

performed

by

an

experienced

team.

Contemporary

robotic

series

also

report favourable outcomes in infants younger than six

months,

although

robotic

technology

introduces

diﬀerent cost and access considerations.

9,17

Multicentre

comparisons

of

open,

conventional

laparoscopic

and

robotic

pyeloplasty

generally

suggest

that

all

three

approaches can be eﬀective when expertise and patient

selection

are

appropriate.

18

The

choice

between

open

and laparoscopic surgery should therefore not be based

on

a

single

numerical

outcome.

Open

pyeloplasty

remains highly eﬀective, uses familiar equipment, and

may be preferred when minimally invasive expertise or

appropriately

sized

instruments

are

unavailable.

Laparoscopy

oﬀers

smaller

incisions

and

shorter

hospitalisation but requires advanced suturing skills and

Comparison of Functional and Morphological Outcomes of Open Versus

72

J Gandhara Med Dent Sci

October - December 2026

longer

theatre

time.

In

resource-limited

environments,

the

incremental

beneﬁt

of

laparoscopy

should

be

balanced

against

operating-room

availability,

equipment

costs,

surgeon

training,

and

case

volume.

The present ﬁndings support laparoscopy as a feasible

alternative rather than evidence that open pyeloplasty is

obsolete. From a counselling perspective, families can

be informed that both approaches in this study produced

success rates above 90% with low short-term morbidity.

The

more

meaningful

trade-oﬀ

was

longer

operative

time for laparoscopy versus shorter postoperative stay,

while

the

observed

diﬀerence

in

renal

functional

improvement was small. This balanced interpretation is

preferable to describing either operation as universally

superior.

LIMITATIONS

The

absence

of

random

allocation

is

the

principal

limitation

because

surgical

approach

depended

on

surgeon

expertise

and

parental

preference,

creating

potential selection bias. The study was conducted at a

single

centre

and

included

58

infants

in

each

group,

limiting

the

precision

of

uncommon

complication

estimates

and

the

ability

to

perform

informative

subgroup

analysis.

Follow-up

was

restricted

to

six

months

and

cannot

establish

late

recurrence,

reoperation,

long-term

diﬀerential

renal

function,

or

durability

of

morphological

recovery.

Overall

renal

function

was

assessed

using

creatinine-based

eGFR

rather than measured GFR, this is particularly important

in

infants,

in

whom

creatinine

and

body

composition

change

rapidly.

The

study

did

not

report

patient-level

baseline

diﬀerential

renal

function

for

adjusted

analysis, and residual confounding may remain despite

similar

group

means.

Ultrasound

outcomes

can

be

affected

by

hydration

and

measurement

variability.

Finally,

the

analysis

was

largely

unadjusted;

future

multicentre

prospective

studies

should

incorporate

standardised imaging, diﬀerential renal function, longer

follow-up, patient-reported or parent-reported recovery,

cost analysis, and multivariable adjustment for baseline

severity.

CONCLUSIONS

Open and laparoscopic pyeloplasty both achieved high

six-month success rates with low complication rates in

infants

with

unilateral

UPJO.

Laparoscopy

was

associated

with

longer

operative

time

but

shorter

hospitalisation

and

somewhat

greater

functional

and

morphological

improvement.

Because

the

study

was

non-randomised and the absolute eGFR diﬀerence was

small, the ﬁndings support laparoscopic pyeloplasty as

an eﬀective alternative rather than deﬁnitive evidence

of superiority over open surgery.

CONFLICT OF INTEREST:

None

FUNDING SOURCES:

None

REFERENCES

1.

Costigan

CS,

Rosenblum

ND.

Understanding

ureteropelvic

junction

obstruction:

how

far

have

we

come?

Front

Urol.

2023;3:1154740.

doi:10.3389/fruro.2023.1154740.

PMID:

40778044.

2.

Hodhod

A,

Fermin-Risso C,

Farhad

M,

Cook

AJ,

Aburezq

J,

Eid

H,

et

al.

Can

we

improve

the

usefulness

of

the

diuretic

renogram in the diagnosis of ureteropelvic junction obstruction

(UPJO)

in

children?

Introduction

of

mercaptoacetyltriglycine-

suspected

obstruction

scoring

system

(MAG-SOS).

J

Pediatr

Urol.

2023;19(3):311.e1-311.e8.

doi:10.1016/j.jpurol.2023.02.022. PMID: 36922332.

3.

Cascini

V,

Lauriti

G,

Di

Renzo

D,

Miscia

ME,

Lisi

G.

Ureteropelvic junction obstruction in infants: open or minimally

invasive surgery? A systematic review and meta-analysis. Front

Pediatr.

2022;10:1052440.

doi:10.3389/fped.2022.1052440.

PMID: 36507128.

4.

Wang M,

Xi

Y, Huang N,

Wang P, Zhang L,

Zhao

M, et al.

Minimally

invasive

pyeloplasty

versus

open

pyeloplasty

for

ureteropelvic

junction

obstruction

in

infants:

a

systematic

review

and

meta-analysis.

PeerJ.

2023;11.

doi:10.7717/peerj.16468. PMID: 38025670.

5.

Ortiz-Seller

D,

Panach-Navarrete

J,

Valls-González

L,

Martínez-Jabaloyas

JM.

Comparison

between

open

and

minimally invasive pyeloplasty in infants: a systematic review

and

meta-analysis.

J

Pediatr

Urol.

2024;20(2):244-252.

doi:10.1016/j.jpurol.2023.11.017. PMID: 38065760.

6.

Andolﬁ

C,

Lombardo

AM,

Aizen

J,

Recabal

X,

Walker

JP,

Barashi

NS,

et

al.

Laparoscopic

and

robotic

pyeloplasty

as

minimally

invasive

alternatives

to

the

open

approach

for

the

treatment

of

uretero-pelvic

junction

obstruction

in

infants:

a

multi-institutional comparison of outcomes and learning curves.

World J Urol. 2022;40(4):1049-1056. doi:10.1007/s00345-022-

03929-0. PMID: 35044490.

7.

Esposito

C,

Cerulo

M,

Lepore

B,

Coppola

V,

D'Auria

D,

Esposito

G,

et

al.

Robotic-assisted

pyeloplasty

in

children:

a

systematic

review

of

the

literature.

J

Robot

Surg.

2023;17(4):1239-1246.

doi:10.1007/s11701-023-01559-1.

PMID: 36913057.

8.

Langreen S, Ludwikowski B, Dingemann J, Ure BM, Hofmann

AD,

Kuebler

JF.

Laparoscopic

pyeloplasty

in

neonates

and

infants

is

safe

and

eﬃcient.

Front

Pediatr.

2024;12:1397614.

doi:10.3389/fped.2024.1397614. PMID: 39132308.

9.

Gao

J,

Zhang

S,

Wang

L,

Wang

X.

Safety

and

eﬃcacy

of

robotic-assisted

laparoscopic

pyeloplasty

for

ureteropelvic

junction

obstruction

in

infants

under

6

months.

Sci

Rep.

2025;15(1):13737.

doi:10.1038/s41598-025-99115-4.

PMID:

40259103.

10.

Ibrahim RB, Srivaths P, Tam E, Devaraj S. Utility of cystatin C-

based equation for the estimation of glomerular ﬁltration rate in

a

pediatric

population.

J

Appl

Lab

Med.

2024;9(4):803-808.

doi:10.1093/jalm/jfae034. PMID: 38656545.

11.

Chu

H,

Deng

Q,

Cao

Y,

Yu

X.

Comparative

analysis

of

laparoscopic

and

transumbilical

incision

open

pyeloplasty

for

treatment

of

infants

with

ureteropelvic

junction

obstruction:

a

clinical

eﬃcacy

and

safety

study.

Transl

Pediatr.

2025;14(2):231-239.

doi:10.21037/tp-2024-503.

PMID:

40115454.

Comparison of Functional and Morphological Outcomes of Open Versus

73

J Gandhara Med Dent Sci

October - December 2026

12.

Christanto

RBI,

Raharja

PAR,

Situmorang

GR,

Wahyudi

I,

Rodjani

A,

Imam

A,

et

al.

Long-term

renal

function

post-

pyeloplasty:

a

systematic

review.

Int

Urol

Nephrol.

2025;57(10):3107-3115.

doi:10.1007/s11255-025-04495-1.

PMID: 40205125.

13.

Shi

T,

Lao

W,

Ouyang

K,

Chen

Y,

Zhang

Y,

Luo

J,

et

al.

Laparoscopic

pyeloplasty

for

newborns

with

severe

hydronephrosis.

Front

Pediatr.

2024;12:1343211.

doi:10.3389/fped.2024.1343211. PMID: 38560400.

14.

Tharanendran

H,

Sundararajan

L,

Babu

R,

Arunachalam

P.

Does

age

inﬂuence

the

functional

recovery

after

infant

pyeloplasty? J Indian Assoc Pediatr Surg. 2024;29(3):219-222.

doi:10.4103/jiaps.jiaps_194_23. PMID: 38912019.

15.

Siregar S, Mustafa A, Steven S. Can we predict renal function

recovery

after

pyeloplasty

in

pediatrics

with

ureteropelvic

junction

obstruction?

A

systematic

review.

Urol

Res

Pract.

2024;50(2):85-93.

doi:10.5152/tud.2024.23220.

PMID:

38798006.

16.

Hodhod A, Eid H, Fermin-Risso C, Farhad M, Aburezq J, Cook

A,

et

al.

Signiﬁcant

improvement

in

hydronephrosis

with

pyeloplasty prior to 3 months of age in patients with antenatal

severe

hydronephrosis.

Int

Urol

Nephrol.

2024;56(8):2467-

2473. doi:10.1007/s11255-024-04002-y. PMID: 38507157.

17.

Zhang X, Zhao Y, Tao T, Cao H, Yi X, Zhou X, et al. Long-

term outcomes of robotic-assisted laparoscopic pyeloplasty for

unilateral ureteropelvic junction obstruction in infants. J Pediatr

Surg.

2025;60(12):162561.

doi:10.1016/j.jpedsurg.2025.162561. PMID: 40818802.

18.

González

ST,

Rosito

TE, Bujons

Tur

A,

Ruiz

J,

Gozalbez

R,

Maiolo

A,

et

al.

Multicenter

comparative

study

of

open,

laparoscopic, and robotic pyeloplasty in the pediatric population

for the treatment of ureteropelvic junction obstruction (UPJO).

Int

Braz

J

Urol.

2022;48(6):961-968.

doi:10.1590/S1677-

5538.IBJU.2022.0194. PMID: 36083265.

Younas

Khan

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation;

Drafting

Manuscript;

Critical

Revision;

Final Approval

Tariq Ahmad

-

Concept & Design; Data Acquisition; Drafting

Manuscript;

Supervision;

Final Approval

Murad

Ali

-

Concept

&

Design;

Data

Acquisition;

Data

Analysis/Interpretation; Drafting Manuscript; Final Approval

Asghar

Ali

-

Concept

&

Design;

Data

Acquisition;

Drafting

Manuscript;

Final Approval

Abdul

Basit

Shah

-

Concept

&

Design;

Data

Acquisition;

Drafting Manuscript;

Critical Revision; Final Approval

.

LICENSE:

JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (

CC-BY-NC-SA 4.0

).

COPYRIGHTS:

Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.

It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.

AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Comparison of Functional and Morphological Outcomes of Open Versus

Adil Muhammad

-

Concept

&

Design;

Data

Acquisition;

Drafting Manuscript;

Critical Revision; Final Approval