Introduction: Barbed sutures are being used in many minimally invasive (laparoscopic, robotic) urological procedures. However, their use in pyeloplasty had been debated, as there were reports of increased complications. We aimed to perform a systematic review and meta-analysis assessing the minimally invasive pyeloplasty outcomes based on the use of barbed or non-barbed sutures.

Methods: A systematic review (CRD42021276949) was performed in accordance with Cochrane Collaboration. A literature search was performed in September 2021 across Medline, EMBASE, Scopus, Cochrane Library, and ClinicalTrials.gov. Records comparing pyeloplasty outcomes between barbed and non-barbed sutures were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I. Effect estimates were extracted as odds ratios (ORs) or mean difference (MD) and corresponding 95% confidence intervals (CI) were pooled using inverse variance method.

Results: A total of six retrospective studies were identified for inclusion. Four studies were included for the meta-analysis (three robotic, one laparoscopic). Study characteristics are summarized in Table 1. Two outcomes were able to be meta-analyzed: operative time and pyeloplasty failure. Barbed sutures led to reduced operating room time (MD -54.38 minutes, 95% CI -61.27 to -47.50], p<0.0001) (Figure 1). However, barbed sutures had higher likelihood of pyeloplasty failures (OR 4.37, 95% CI 1.14–16.75, p=0.03) (Figure 2). The overall risk of bias in the studies was high. 

Conclusions: While limited by the high risk of bias present in the studies and the limited number of studies available for meta-analysis, barbed sutures appear to have higher rates of pyeloplasty failure compared to non-barbed sutures. While they may confer benefits of faster operative time, well-designed, prospective studies are required to demonstrate non-inferiority prior to routine use of barbed sutures in pyeloplasty.