Megaureter-Advanced Techniques for Surgical Management: An Updated Review Article.

Abstract

Background: Megaureter, characterized by the dilation of the ureter often exceeding 7-8 mm, is a common condition diagnosed in pediatric patients, typically through ultrasound imaging. Identifying the underlying cause of megaureter is crucial to determine whether conservative management or surgical intervention is needed. King's classification is a key tool for categorizing megaureters based on the presence of obstruction and vesicoureteral reflux (VUR). Surgical strategies aim to restore normal ureteral function by addressing obstruction or reflux. The rise of minimally invasive techniques, such as endoscopic balloon dilation (EBD) and laparoscopic ureteroneocystostomy (UNC), reflects the evolving trends in pediatric urology.

Aim: This article reviews the current advances in surgical management techniques for megaureter, focusing on the evolution of surgical interventions, particularly minimally invasive methods.

Methods: The review synthesizes various studies and clinical approaches, evaluating traditional and contemporary surgical interventions, including open ureteral reimplantation (UNC), endoscopic balloon dilation (EBD), and robotic-assisted techniques. Diagnostic criteria such as voiding cystourethrogram (VCUG), diuretic renograms (DR), and ultrasonography are also discussed.

Results: Minimally invasive procedures like EBD have gained popularity due to their non-invasive nature and high success rates, ranging from 60-100%. The article highlights the challenges of these procedures, such as the risk of introducing VUR, but also emphasizes their potential to replace traditional open surgeries. The review presents the advantages of EBD, such as reduced morbidity, shorter recovery times, and fewer complications compared to open reimplantation.

Conclusion: Advances in the surgical management of megaureter, especially with minimally invasive techniques, provide significant benefits, including improved outcomes, reduced complication rates, and faster recovery times. Despite the promising results of endoscopic procedures, further prospective studies are required to refine surgical indications and outcomes across diverse patient populations.