Trifecta Outcomes in Pediatric Pyeloplasty: A Comparative Analysis of Standard Versus Mini-Laparoscopic Techniques

Objective: The primary aim of this study was to compare perioperative and functional outcomes between conventional laparoscopic pyeloplasty (CLP) and mini-laparoscopic pyeloplasty (MLP) in pediatric patients. As a secondary objective, we evaluated a composite trifecta outcome, defined as a structured summary measure rather than a validated endpoint. Methods: This retrospective study included 129 pediatric patients (<18 years) who underwent CLP ( n = 67) or MLP ( n = 62) between August 2009 and February 2025. Trifecta success was defined as a composite outcome comprising: (1) a ≥14 mm reduction in AP pelvic diameter, (2) absence of obstruction on postoperative scintigraphy, and (3) absence of postoperative complications. Univariate logistic regression analysis was performed to identify predictors of trifecta success. Results: The mean age was 7.2 ± 5.8 years, and 33.3% of patients were female. Operative time was significantly longer in the CLP group (113 ± 35.5 versus 90.6 ± 26.2 minutes; P = .001), whereas anastomosis time was comparable between groups ( P = .152). Minor complications occurred in 16.5% of patients. Receiver operating characteristic analysis demonstrated that a reduction in AP diameter ≥14 mm predicted trifecta success, with an AUC of 0.659, sensitivity of 52.8%, and specificity of 80%. Overall, trifecta success was achieved in 76.7% of patients, with no significant difference between CLP and MLP (74.6% versus 79%, P = .677). Logistic regression analysis did not identify any significant predictors of trifecta success, including surgical technique (odds ratio [OR] 1.528, P = .361). Conclusion: CLP and MLP are safe and effective approaches with comparable perioperative and functional outcomes. The proposed trifecta criteria may provide a structured framework for outcome assessment; however, external validation is warranted. Future prospective multicenter studies incorporating patient-reported outcomes are needed to better define the clinical impact of instrument miniaturization in pediatric urology.