WOFAPS 2025 8th World Congress of Pediatric Surgery

Wenchang Huang, Guangjie Chen

Children's Hospital, Zhejiang University School of Medicine, Department of Urology, Hangzhou, China.

Objective: To compare perioperative outcomes of Pneumovesicoscopic Politano-Leadbetter (PL) versus Robot-Assisted Laparoscopic Lich-Gregoir (RALG) in pediatric primary obstructive megaureter (POM) through age-stratified analysis.

Methods: This retrospective study analyzed 68 POM children (2020-2024), stratified into <2 years (PL, n=10; RALG, n=25) and ≥2 years (PL, n=14; RALG, n=19). Outcomes included demographics, preoperative hydronephrosis/ureteral dilation metrics, postoperative drainage duration, hospitalization length, double-J stent duration, Clavien-Dindo complications, recurrence, and symptom resolution.

Results: In the <2-year-old group: RALG significantly shortened hospitalization vs PL (median 8.0 [IQR 7.0–10.0] vs 10.5 [8.0–14.75] days; P=0.015) and required more ureteral tailoring (88.0% vs 55.6%; P<0.001). No significant differences in operative time, complication grade, or recurrence rate. In the ≥2-year-old group: PL reduced double-J stent duration vs RALG (34.5 [30.25–40.75] vs 49.0 [43.0–56.0] days; P=0.002) and had lower drainage tube utilization (14.3% vs 100%; P<0.001). Hospitalization, operative time, complications, and 6-month resolution rates were comparable. Cox regression identified age <2 years as a predictor for delayed symptom resolution (HR=0.525; P=0.023), supported by Kaplan-Meier analysis (P<0.05).

Conclusion: RALG reduces hospitalization for children <2 years, while PL decreases double-J stent duration and drainage requirements for those ≥2 years. Younger age is an independent predictor of delayed postoperative resolution, supporting age-specific surgical selection. This study supports an age-based individualized surgical approach for obstructive megaureter patients, while long-term efficacy comparisons require larger cohorts and extended follow-up.