Comparison of Cosmetic Results in Children >10-Year-Old Undergoing Open, Laparoscopic, or Robotic-Assisted Pyeloplasty: A Multicentric Study

Purpose: To compare surgical scars assessed by a validated patient reported outcome questionnaire in children undergoing open (OP), laparoscopic (LP), or robotic-assisted (RALP) pyeloplasty. Secondary aim was to assess the influence on the outcomes of variables such as gender or body mass index (BMI). Materials and methods: Observational, cross-sectional, multicentric study of patients undergoing primary pyeloplasty between age 10- and 18-year at 5 tertiary Italian institutions in the period 01/2010 to 12/2019. Of 227 eligible patients, 114 (50%) participated. OP was performed in 37 (32%), LP in 30 (26%) and RALP in 47 (41%), After a median (IQR) follow-up of 5.2 (2.3-7.8) years, scars were measured and assessed by a validated Patient Scar Assessment Questionnaire (PSAQ). Scores were compared among techniques and in accordance to several variables. Results: The median length of the surgical scar at follow-up was significantly larger (p <0.0001) after OP (8.1 cm vs. 1.8 cm for LP and 2.0 cm for RALP), where scar length correlated (p=0.04) with BMI. Ninety patients (79%) had a PSAQ score within the first quartile, the most favorable. During follow-up, 43 (38%) participants reported scar related symptom. Symptoms were generally more common after OP (54% vs. 30% for LP and 30% for RALP, p=0.06) and scar hyperesthesia was significantly more frequent after OP (p=0.01). Conclusions: Perception of the cosmetic outcomes in pre-adolescents and adolescents after pyeloplasty was generally good. LP achieved the best cosmetic results. OP was more commonly associated with scar related symptoms and the size of the incision paralleled BMI.