Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes

Abstract

Background and Objective: Primary obstructive megaureter (POM) has various courses in different age populations. Although open ureteral reimplantation (OUR) remains the standard treatment for symptomatic POM, it is highly invasive with potential complications. In recent years, minimally invasive ureteral reimplantation (MIUR), including laparoscopic ureteral reimplantation (LUR) and roboticassisted laparoscopic ureteral reimplantation (RALUR), and endoscopic management, such as double-J stent insertion, endoureterotomy and endoscopic balloon dilatation (EBD), have been utilized for POM in selected patients. However, few comparable studies between MIUR and endoscopic management have been published to date, and it remains unclear which surgical management is the optimal choice for POM in different age groups. This review provides a comprehensive perspective on technical development and clinical outcomes of MIUR and endoscopic management for POM in pediatric and adult populations. Methods:The PubMed and Web of Science databases were used to comprehensively search English language articles related to MIUR and endoscopic management for POM in pediatric and adult populations up to March 2022. The technical modifications and the relevant clinical outcomes were reviewed. Key Content and Findings: MIUR with various technical modifications related to intracorporealsuturing and ureteroneocystostomy with anti-reflux techniques appears to be as safe and effective for POM in different age groups as the open procedure. Double-J stent insertion should be regarded as a temporary option for infants by achieving internal urinary drainage, as it may present limited success rates and various complications. Endoureterotomy using pure cutting current or laser appears to be a safer, easier, and less invasive alternative to open surgical management. While EBD has emerged as a definite treatment for POM in the pediatric population, it is debatable whether EBD can substitute for MIUR in adult patients. Conclusions:The safety and feasibility of MIUR and endoscopic management in patients from all age groups still need further investigation.

Combined Minimally Invasive Treatment of Pyeloureteral Junction Obstruction and Primary Obstructive Megaureter in Children: Case Report and Literature Review

“…Reviewing the literature, we found 110 patients with the association of PUJO and POM reported in 10 articles (Table 1) [3,[13][14][15][16][17][18][19][20][21][22]. The available literature showed that the diagnosis of double obstruction was carried out in 67.3% of cases.…”

“…Reviewing the literature, we found 110 patients with the association of PUJO and POM reported in 10 articles (Table 1) [3,[13][14][15][16][17][18][19][20][21][22].…”

“…Procedures such as HPBD and endoureterotomy are carried out via the urinary tract without necessitating skin incisions. These techniques offer a viable option for releasing obstruction and facilitating urinary drainage without the need for excising the distal ureteral segment [22].…”

“…Specifically, HPBD of the ureterovesical junction has surfaced as a definitive therapeutic approach for POM in pediatric patients, demonstrating satisfactory success rates and minimal occurrences of complications (mainly transient hematuria, urinary tract infections, and occurrences of stent intolerance or migration) [22]. It has comparable success with classic reimplantation (86% vs. 91%), but it offers a minimally invasive approach that is safe and feasible even for patients under 1 year of age [23,24].…”

“…Additionally, attempts have been made to combine EBD with endoureterotomy or perform it without fluoroscopic guidance. Endoureterotomy has been conducted utilizing either a pure cutting electrical current or laser technology, reaching satisfactory success rates of around 90%, coupled with a minimal occurrence of complications, and presenting as well as HPBD, a minimally invasive substitute to traditional open surgical interventions [22]. In particular, if the stenotic ring is still visible after HPBD, endoureterotomy could be considered, being a technique that allows to keep the vascularity intact and allows a simplified healing of the muscular layer with the JJ stent left in place [18,23].…”