Minimally invasive options in the management of primary obstructive megaureter in children: a narrative review

Management of primary obstructed megaureter (POM) in children has always been a matter of debate with conflicting reports claiming superiority of the reported technique. Multiple minimally invasive surgery (MIS) treatment options have become popular recently. In this narrative review, we have discussed the pros and cons of different MIS options available in the treatment of POM in children.

Contemporary literature from 2003 to 2023 was searched for primary obstructive megaureter, endoscopic management, double-J stenting, endoureterotomy, balloon dilatation, laparoscopic and robotic reimplantations. Review articles, guidelines, case series and technical innovations related to POM were included. Individual case reports, adult POM management articles and animal studies were excluded.

A total of 1023 articles were initially screened. After applying inclusion criteria the search results were filtered to 210 articles. After applying exclusion criteria, 44 articles were used for this narrative review.

Cystoscopic internal urinary drainage by double-J stent insertion seems attractive but has limited success rates and should be reserved in infants as a temporising option. Endoureterotomy offers a less invasive alternative to open surgical management but has not been fully established. The mean success rate of endoscopic balloon dilatation is 85 to 90% compared to 90 to 95% for minimally invasive ureteric reimplantation. In infants Shanfied type reimplantations have been shown to have good results in the early follow-up. In older children, vesicoscopic, laparoscopic and robotic reimplantations with or without tailoring have a high success rate and should be the preferred MIS option in the management of POM.