Endoscopic Management of Primary Obstructive Megaureter: A Systematic Review

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Urologic Oncology

Background:

• Primary obstructive megaureter (POM) is a congenital condition affecting the ureter.
• Traditional treatment involves ureteral reimplantation, which can be invasive for infants.
• Endoscopic management presents a less invasive alternative.

Purpose of the Study:

• To systematically review the literature on endoscopic management of POM in pediatric patients.
• To evaluate the efficacy and outcomes of various endoscopic techniques.
• To compare endoscopic approaches with traditional open surgery.

Main Methods:

• Systematic literature search of multiple databases (MEDLINE/Ovid, PubMed, Embase, Web of Science).
• Inclusion of full-text English articles with more than one pediatric case.
• Independent data extraction and strength of evidence assessment by two authors.

Main Results:

• 12 studies (11 retrospective, 1 prospective) involving 222 patients were analyzed.
• Common endoscopic approaches included balloon dilation and ureterotomy with stenting.
• Overall anatomic and functional success rates were 79.3% and 76.7%, respectively.
• Higher success rates observed in children aged 12 months or older (82.3% anatomic success).
• 15.1% required endoscopic retreatment, and 36.7% needed surgical reintervention.
• Complications were generally mild, with 12 cases of vesicoureteral reflux.

Conclusions:

• Endoscopic management is a viable, minimally invasive alternative for POM in children over 12 months.
• In infants, endoscopic procedures may serve as a temporizing measure.
• A significant proportion of patients (approximately one-third) may require further surgical intervention.