Comment on: “Single Port vs Multiple Port Robot-Assisted Laparoscopic Pyeloplasty for the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis” by Gu et al .

Dear Editor:

We have read with great interest the recent publication by Gu et al. in the Journal of Endourology. ¹ Their study aimed to compare the safety and feasibility of single-port robot-assisted pyeloplasty (SP-RP) and multiport robot-assisted pyeloplasty (MP-RP) for treating ureteropelvic junction obstruction (UPJO) through a systematic review and meta-analysis. According to their findings, SP-RP offers greater advantages in terms of aesthetics and patient-reported pain compared with MP-RP, while also maintaining higher treatment efficacy and safety. This discovery will guide clinicians in making evidence-based decisions regarding UPJO treatment. We commend the authors for their significant contribution and hard work in this area. However, we provide some thoughts on this clinical issue.

Although systematic reviews and meta-analyses can provide higher quality evidence for clinical issues, the inclusion process of the study population warrants attention to certain details. Based on the inclusion criteria proposed by the authors, we found that the article lacked attention to preoperative renal function data. Although the authors compared the postoperative final renal function recovery results between MP-RP and SP-RP, we believe that evaluating preoperative renal function is an important factor.

Providing patients with preoperative renal function data would help to assess whether the baseline characteristics of UPJO in the study were equivalent. Recently, Nordenström et al. conducted retrospective studies to evaluate the possible factors affecting postoperative renal function in patients who underwent UPJO pyeloplasty and found that preoperative differential renal function was an independent predictor for postoperative renal function improvement (p = 0.0045), ² but this article did not analyze the potential consequences of such differences. Therefore, the lack of analysis of preoperative results may lead to bias in the author's conclusion.

Moreover, it is necessary to classify the complications of the two different surgical procedures according to the Clavien classification of surgical complications. ³ Most of the studies included by the authors reported the classification or detailed description of surgical complications using the Clavien classification. Although the authors stated that there was no difference in the incidence of complications between SP-RP and MP-RP, comparing the severity of complications should also be included in the analysis of the study results. Adding these results to the literature can help many readers better understand the article.

Because this article is a systematic review and meta-analysis, we have another potential concern. According to the latest guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, systematic reviews and meta-analyses should be registered on PROSPERO with the registration name and number provided in the article. ⁴ Although the authors have mentioned that they followed the PRISMA guidelines, the research project has not been registered on PROSPERO. The authors have conducted a comprehensive and commendable analysis of the existing evidence to address the current controversies, and it is necessary to address the above issues to enhance the comprehensiveness and persuasiveness of their findings.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

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