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JU INSIGHT Comparison of Cosmetic Results in Children >10 Years Old Undergoing Open, Laparoscopic or Robotic-Assisted Pyeloplasty: A Multicentric Study
By: Filippo Ghidini, MD; Giulia Bortot, MD; Michele Gnech, MD; Giorgia Contini, MD; Maria Escolino; Ciro Esposito; Nicola Capozza, MD; Alfredo Berrettini, MD, PhD; Lorenzo Masieri; Marco Castagnetti | Posted on: 01 May 2022
Ghidini F, Bortot G, Gnech M et al: Comparison of Cosmetic Results in Children >10 Years Old Undergoing Open, Laparoscopic or Robotic-Assisted Pyeloplasty: A Multicentric Study. J Urol 2021; https://doi.org/10.1097/JU.0000000000002385.
Table. Scores of PSAQ
| Overall | OP | LP | RALP | p Value | |
| No. pts | 114 | 37 | 30 | 47 | |
| Median PSAQ (IQR) | 42 (37–48) | 43 (39–48) | 41 (34–43) | 43 (38–50) | 0.03* |
| Median appearance (IQR) | 15 (13–16) | 15 (13–16) | 14 (12–15) | 15 (14–18) | 0.002* |
| Median consciousness (IQR) | 9 (8–11) | 10 (8–11) | 8 (7–10) | 9 (8–10) | 0.09 |
| Median satisfaction with appearance (IQR) | 12 (9–15) | 12 (9–15) | 11 (8–14) | 13 (9–16) | 0.13 |
| Median satisfaction with symptoms (IQR) | 5 (5–7) | 6 (5–7) | 5 (5–6) | 5 (5–6) | 0.49 |
*Significant for p value ≤0.05.
Study Need and Importance
Minimally invasive pyeloplasty (MIP), including laparoscopic pyeloplasty (LP) and robotic-assisted laparoscopic pyeloplasty (RALP), has become increasingly popular. Reportedly, MIP has success and complication rates comparable to open pyeloplasty (OP), and therefore potential advantages have to be searched for in secondary outcomes. Improved cosmesis is often claimed as a major advantage of MIP, and older children and adolescents are generally considered the patients who could benefit the most from MIP. This is the first multicentric study comparing patient perception of surgical scars using a validated Patient Scar Assessment Questionnaire (PSAQ) in children >10 years old undergoing OP, LP or RALP.
What We Found
Of 227 eligible patients, 114 (50%) participated, including 37 (32%) OP, 30 (26%) LP and 47 (41%) RALP. Median (IQR) followup was 5.2 (2.3–7.8) years. The PSAQ score was within the first quartile, the most favorable, in 90 (79%) patients without difference among approaches. LP achieved significantly better PSAQ scores, whereas no difference was observed between RALP and OP (see table). More than half of the patients undergoing OP reported scar related symptoms. Median scar length at followup was significantly larger after OP where it correlated with body mass index, whereas it did not do so after MIP.
Limitations
Collection of some clinical data was retrospective and patient reported outcome questionnaires are keen to bias. Results might be largely modified by the outcomes in nonrespondents. The occurrence of some variables might have been too small to reach statistical significance. Results might be different after pyeloplasty in infancy.
Interpretation for Patient Care
Patients were generally satisfied with scar appearance; therefore, this study does not support the hypothesis that, in this age group, MIP allows for better cosmetic results than OP. OP incisions were more commonly associated with scar-related symptoms. MIP might be advisable in overweight and obese patients.