Comparison of Functional and Morphological Outcomes of Open Versus Laparoscopic Pyeloplasty in Infants with Ureteropelvic Junction Obstruction

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.