A comparative study of endoscopic balloon dilatation and laparoscopic ureteral replantation in the treatment of primary obstructive megaureter.

Purpose: Surgical intervention may be required in some children with primary obstructive megaureter (POM) and laparoscopic ureteral reimplantation (LUR) is regarded as the standard approach. With the recent development of endoscopic technology, endoscopic balloon dilation (EBD) has gained popularity. We sought to describe our initial experience with EBD in treating POM, and to compare efficiency and safety with the LUR.

Methods: A retrospective chart review was performed on children who underwent EBD or LUR between January 2019 and July 2021. Patient demographics, clinical manifestation and perioperative parameters, complications and primary outcomes were analyzed.

Results: A total of 6 patients underwent EBD and 13 underwent LUR during the study period. There were no significant differences in the demographics, clinical manifestation and pre-operative renal function between the EBD and the LUR groups. Although the EBD series was associated with shorter operative time (p < 0.001), less blood loss (p < 0.001), and shorter postoperative hospitalization (p < 0.001), patients undergoing LUR had a higher success rate (p < 0.01).

Conclusions: Our preliminary results suggested that the EBD, though more non-invasive, seems less effective in the surgical management of POM. The "one size fits all" approach of EBD does not work with POM. Perhaps the EBD is not effective for all children with POM, but for some specific subtypes. Further studies were needed to better clarify the optimal indications of EBD.