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Oral Presentation - 89
Minimally Invasive Approaches for Pediatric Primary Obstructive Megaureter: A Prospective Comparative Study
Sarra Chennouf 1, Aida el Gouacem 2, Hichem Choutri 3, amina amel bensebti 3, Zoubir Atrih 1
1 Boubnider University constantine3, Faculty of medecine, Department of pediatric surgery SMK Constantine
2 establishment mother child sidi Mabrouk Constantine
3 Boubnider University Constantine ,Faculty of medecine, Department of pediatric critical care unit SMK Constantine
Background: Primary obstructive megaureter (POM) is a congenital anomaly of the ureter characterized by functional obstruction at the ureterovesical junction. Although open ureteral reimplantation has long been considered the standard treatment, minimally invasive techniques have emerged as effective alternatives with reduced surgical morbidity.
To evaluate the safety, feasibility, and short-term outcomes of two minimally invasive techniques for the management of POM
Methods: We conducted a prospective study including 30 pediatric patients diagnosed with symptomatic POM. Seventeen patients underwent endoscopic high-pressure balloon dilation (HPBD) of the ureterovesical junction, while 13 patients were treated by laparoscopic extravesical ureteral reimplantation using the Shanfield technique. Preoperative assessment included ultrasonography, voiding cystourethrography, and diuretic renal scintigraphy. Patients were followed clinically and radiologically using serial ultrasonography, with renal scintigraphy performed at 12 months postoperatively. Outcomes assessed included operative time, hospital stay, postoperative complications, improvement in ureteral dilatation, drainage on renal scintigraphy, preservation of renal function, and the need for secondary procedures.
Results: Both minimally invasive approaches were successfully completed without conversion to open surgery. They were associated with low perioperative morbidity and satisfactory postoperative recovery. Progressive improvement in ureteral dilatation and urinary drainage was observed during follow-up, while differential renal function remained stable or improved in most patients. Endoscopic balloon dilation offered shorter operative time and hospital stay, making it an attractive first-line option in selected patients. Laparoscopic extravesical reimplantation provided definitive anatomical correction with excellent functional outcomes, particularly in patients with marked ureteral dilatation or those unsuitable for endoscopic treatment. Overall success rates were high in both groups, with only a limited number of patients requiring additional intervention.
Conclusions: Both HPBD and laparoscopic extravesical Shanfield ureteral reimplantation are safe and effective minimally invasive options for the treatment of pediatric POM. Appropriate patient selection is essential to optimize outcomes. Larger studies with longer follow-up are recommended.