Comparative Study of No-Touch Technique Combined with Minimal Renal Pelvis Incision in Laparoscopic Pyeloplasty versus Conventional Approach for Pediatric UPJO

Abstract Background Laparoscopic pyeloplasty (LP) is an effective treatment for pediatric ureteropelvic junction obstruction (UPJO). However, evidence regarding the perioperative and follow-up outcomes of LP combining a minimal renal pelvis incision with a no-touch technique remains limited. Purpose To compare laparoscopic pyeloplasty with a minimal renal pelvis incision and a no-touch technique versus standard laparoscopic pyeloplasty for treating pediatric UPJO. Methods This retrospective cohort study included 120 pediatric patients with UPJO who underwent surgery at the Children’s Hospital of Nanjing Medical University between January 2022 and June 2024. Among the 120 patients, 103 were male, 17 were female, and the median age was 68.0 months. One hundred cases were left-sided, and 20 were right-sided. The modified group (MG, n = 63) received laparoscopic pyeloplasty with a minimal renal pelvis incision and no-touch technique, whereas the control group (CG, n = 57) underwent standard LP. There were no significant differences between the groups in terms of sex, age, affected side, or preoperative hydronephrosis severity (P > 0.05). Perioperative outcomes, postoperative complications, and follow-up renal pelvis APD were compared. Results All procedures were completed laparoscopically without conversion to open surgery. Compared with the CG, the MG had shorter operative time (85.0 vs. 100.0 min; P < 0.05), lower intraoperative blood loss (6.0 vs. 10.0 mL; P < 0.05), a shorter postoperative hospital stay (5.0 vs. 7.0 days; P < 0.001), and shorter postoperative hematuria duration (3.0 days, IQR 1.0–4.0 vs. 3.0 days, IQR 2.0–5.0; P < 0.05). D-J tube blockage occurred in one patient (1.59%) in the MG and three patients (5.26%) in the CG. Although this difference did not reach statistical significance (P > 0.05), the incidence of D-J tube blockage was numerically lower in the MG than in the CG. At a mean follow-up of 13.0 ± 5.5 months, no significant between-group difference was observed in renal pelvis APD (P > 0.05). Redo pyeloplasty was required in one patient in each group, corresponding to rates of 1.59% in the MG and 1.75% in the CG, with no significant difference (P > 0.05). Conclusion Compared with standard laparoscopic pyeloplasty, modified laparoscopic pyeloplasty using a minimal renal pelvis incision and no-touch technique was associated with improved perioperative outcomes, including shorter operative time, reduced intraoperative blood loss, shorter hospital stay, and shorter postoperative hematuria duration. Redo pyeloplasty rates and follow-up renal pelvis APD were comparable between groups. Although the incidence of D-J tube blockage was numerically lower in the MG than in the CG, this difference was not statistically significant. These findings suggest that the modified technique is a feasible alternative to standard laparoscopic pyeloplasty for pediatric UPJO, although prospective studies with longer follow-up are needed to confirm its clinical value.