Comparative Effectiveness of Surgical Approaches in Pediatric Ureteroureterostomy: A Systematic Review and Network Meta-Analysis of Open, Laparoscopic, and Robotic Techniques

Introduction: Ureteroureterostomy is a viable option for the management of duplex ureters with associated obstruction, reflux, or incontinence in upper or lower systems. Recent advancements in pediatric urology have fostered a growing interest in comparing the safety, efficacy, and outcomes of the open, laparoscopic, and robotic techniques. Herein, this systematic review and network meta-analysis (NMA) aim to evaluate the safety, efficacy, and outcomes of these three surgical approaches in pediatric patients. Methods: A systematic literature review of Medline, Embase, and Web of Science identified studies comparing these surgical approaches in children (<18 years old). NMA assessed treatment effects using log odds ratios and mean differences with random effects. Heterogeneity and inconsistency were evaluated, and the risk of bias was assessed using the ROBINS-I tool. Results: Seven retrospective studies with 277 children (76 robotic, 124 laparoscopic, and 77 open) were included. There was no difference in age at operation across surgical techniques. No statistically significant difference in operative time was observed, but significant heterogeneity was noted ( I 2 = 75.2%, p = 0.0012). Overall complication rates ranged from 0% to 31.6% and were similar across all techniques. Clavien–Dindo ≥ 3 complications were low (0–11.1%) and did not significantly differ between approaches. Surgical success rates were comparable across techniques. Funnel plot demonstrated minimal likelihood of publication bias. ROBINS-I risk of bias evaluation demonstrated a serious risk of bias because of confounding from retrospective study designs. Conclusion: Based on our NMA, no surgical approach demonstrated clear superiority in operative time, complications, or success rates. Therefore, surgeons should choose the technique of ureteroureterostomy based on their expertise, comfort, and patient factors.