Preoperative ureteral rest and outcomes of robot-assisted upper urinary tract reconstruction: a systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed whether preoperative ureteral rest is associated with outcomes after robot-assisted ureteral reconstruction or pyeloplasty. Five retrospective comparative studies included 707 patients: 478 with ureteral rest and 229 undergoing immediate reconstruction. Ureteral rest was associated with higher pooled surgical success (OR 2.82, 95% CI 1.57 to 5.07; 93.5% vs 86.5%) and modestly lower estimated intraoperative blood loss (MD -23.91 mL, 95% CI -35.79 to -12.03). No statistically significant differences were detected in operative time, hospital stay or postoperative complications.

Key findings

• Surgical success was 93.5% with ureteral rest versus 86.5% without; pooled OR 2.82, 95% CI 1.57 to 5.07.
• Estimated intraoperative blood loss was lower with ureteral rest (MD -23.91 mL, 95% CI -35.79 to -12.03; three studies).
• No statistically significant differences were detected in operative time, length of stay or postoperative complications.
• Subgroup analyses found no significant interaction by indication; the ureteropelvic junction obstruction subgroup estimate was imprecise.

Why it matters

Preoperative ureteral rest may be associated with better surgical success and slightly less blood loss in robot-assisted upper urinary tract reconstruction. These outcomes are relevant when considering preoperative drainage and timing of reconstruction. However, the evidence comes from retrospective comparisons and does not establish that ureteral rest causes improved outcomes or clarify whether associations differ by indication.

What to keep in mind

Evidence was limited to five retrospective studies with heterogeneous indications, definitions and reconstructive techniques. The ureteropelvic junction obstruction subgroup included only two studies, and its confidence interval was wide.