Objective To explore the therapeutic efficacy and technical characteristics of pneumovesical Cohen ureteral reimplantation (PCUR) versus laparoscopic dismembered Lich-Gregoir ureteral reimplantation (LLGR) in the treatment of primary obstructive megaureter (POM) in Paediatric Patients. Methods A retrospective analysis was performed on 94 paediatric patients with unilateral POM who were admitted to the Department of Paediatric Surgery, The First Affiliated Hospital of Zhengzhou University between October 2017 and October 2023. Based on the surgical approach, patients were allocated into two groups: 51 cases underwent PCUR, constituting the PCUR group; the remaining 43 cases underwent LLGR, forming the LLGR group. Preoperative baseline characteristics, intraoperative metrics, and postoperative outcomes were compared between the cohorts. The study specifically evaluated the changes in the renal pelvis anteroposterior diameter (APD), the maximum distal ureteral diameter (MDUD), and differential renal function (DRF) on the affected side, comparing preoperative and postoperative values. Results No significant differences were observed in preoperative baseline characteristics between the PCUR and LLGR groups. Compared to the PCUR group, the LLGR group was associated with a significantly shorter operative time (Z=−1.473, P = 0.015) and a reduced duration of postoperative haematuria (Z = −4.843, P < 0.001). Preoperative and postoperative measurements of the affected-side APD, MDUD, DRF and RCT were comparable between the two groups, with no statistically significant differences identified. However, intragroup analysis demonstrated a significant postoperative improvement in all three parameters (APD, MDUD, DRF and RCT) within both surgical cohorts. Furthermore, the magnitude of improvement, defined as the delta (Δ) values for APD (ΔAPD; t = −0.310, P = 0.758), MDUD (ΔMDUD; t = −0.418, P = 0.678), DRF (ΔDRF; t = −1.526, P = 0.129), and RCT(△RC; t = −0.431, P = 0.668), did not differ significantly between the groups. Conclusion Both PCUR and LLGR are safe and effective in treating paediatric POM. Compared with PCUR, LLGR offers advantages including shorter operative time, reduced duration of postoperative haematuria, broader age range applicability, more spacious surgical field, lower technical difficulty in ureteral tailoring, and no compromise to subsequent endoscopic interventions.

A comparative study of pneumovesical Cohen versus laparoscopic dismembered Lich-Gregoir ureteral reimplantation for primary obstructive megaureter in children

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发表日期：

2025年12月23日

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Pengpeng Liu,
Longfei Chen,
Yingzhong Fan

摘要

Objective

To explore the therapeutic efficacy and technical characteristics of pneumovesical Cohen ureteral reimplantation (PCUR) versus laparoscopic dismembered Lich-Gregoir ureteral reimplantation (LLGR) in the treatment of primary obstructive megaureter (POM) in Paediatric Patients.

Methods

A retrospective analysis was performed on 94 paediatric patients with unilateral POM who were admitted to the Department of Paediatric Surgery, The First Affiliated Hospital of Zhengzhou University between October 2017 and October 2023. Based on the surgical approach, patients were allocated into two groups: 51 cases underwent PCUR, constituting the PCUR group; the remaining 43 cases underwent LLGR, forming the LLGR group. Preoperative baseline characteristics, intraoperative metrics, and postoperative outcomes were compared between the cohorts. The study specifically evaluated the changes in the renal pelvis anteroposterior diameter (APD), the maximum distal ureteral diameter (MDUD), and differential renal function (DRF) on the affected side, comparing preoperative and postoperative values.

Results

No significant differences were observed in preoperative baseline characteristics between the PCUR and LLGR groups. Compared to the PCUR group, the LLGR group was associated with a significantly shorter operative time (Z=−1.473, P = 0.015) and a reduced duration of postoperative haematuria (Z = −4.843, P < 0.001). Preoperative and postoperative measurements of the affected-side APD, MDUD, DRF and RCT were comparable between the two groups, with no statistically significant differences identified. However, intragroup analysis demonstrated a significant postoperative improvement in all three parameters (APD, MDUD, DRF and RCT) within both surgical cohorts. Furthermore, the magnitude of improvement, defined as the delta (Δ) values for APD (ΔAPD; t = −0.310, P = 0.758), MDUD (ΔMDUD; t = −0.418, P = 0.678), DRF (ΔDRF; t = −1.526, P = 0.129), and RCT(△RC; t = −0.431, P = 0.668), did not differ significantly between the groups.

Conclusion

Both PCUR and LLGR are safe and effective in treating paediatric POM. Compared with PCUR, LLGR offers advantages including shorter operative time, reduced duration of postoperative haematuria, broader age range applicability, more spacious surgical field, lower technical difficulty in ureteral tailoring, and no compromise to subsequent endoscopic interventions.