Introduction: Ureteropelvic junction obstruction (UPJO) is a common cause of hydronephrosis in children and may require surgical correction when conservative management fails. The role of urinary drainage methods, particularly the use of ureteral stents, in pediatric pyeloplasty remains debated. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of Stentless pyeloplasty compared to stented procedures in pediatric patients with UPJO. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024621563). A comprehensive search was conducted in five databases (PubMed, ProQuest, Cochrane, ScienceDirect, and EBSCOhost) up to December 2, 2024. Eligible studies included children (<18 years) undergoing pyeloplasty with or without stent placement. Outcomes assessed included operative time, hospital stay, complication rates, recurrence, and renal function. Data analysis was performed using Review Manager version 5.4. Risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool and the Newcastle-Ottawa Scale (NOS). Results: Nine studies (four randomized controlled trials and five retrospective cohort studies) involving 788 pediatric patients (451 Stentless, 337 stented) were included. Operative time was similar between groups (mean difference [MD]: –6.03 minutes; 95% confidence interval [CI]: –21.29 to 9.24). Stentless pyeloplasty was associated with a slightly longer hospital stay (MD: 1.00 day; 95%CI: 0.24 to 1.77). No significant differences were observed in complication rates (odds ratio [OR]: 1.16; 95%CI: 0.71–1.89), recurrence (OR: 1.05; 95%CI: 0.36–3.03), or renal function improvement (MD: 0.00; 95%CI: –3.28 to 3.28). Conclusion: Stentless pyeloplasty demonstrates comparable safety and efficacy to stented procedures in the pediatric population. While it may reduce infection risks, the risk of urinary leakage may increase. Individualized surgical decision-making is advised. Further high-quality studies are needed. © 2025 Urology Research Center (URC), Tehran University of Medical Sciences.