Endoscopic techniques in the treatment of vesicoureteral junction obstruction in children with primary obstructive megaureter: A systematic review and meta-analysis.

In 30 seconds

This systematic review and meta-analysis assessed endoscopic treatment of vesicoureteral junction obstruction in children with primary obstructive megaureter. It included 27 studies involving 789 children and 816 renal units, covering seven endoscopic strategies. Reported treatment success varied from 26% to 100%, with nine different definitions. In definition-specific pooled analyses, success ranged from 0.84 to 0.95 for balloon dilatation with stenting and from 0.91 to 1.00 for vesicoureteral junction incision with stenting. The authors concluded that some techniques appear effective in selected children, but comparisons are limited by substantial variation across studies.

Key findings

• Across 27 studies, reported treatment success ranged from 26% to 100%, using nine different definitions.
• Pooled, definition-specific success ranged from 0.84 to 0.95 for balloon dilatation with stenting and 0.91 to 1.00 for junction incision with stenting.
• Reimplantation after treatment was most frequent with stenting alone (53.7%), versus 2.1%-20% with distal ureter-modifying techniques.
• Reported complications were mainly stent-related.

Why it matters

The review brings together outcomes for several endoscopic options in a paediatric condition where their relative effectiveness is uncertain. Its findings suggest that selected approaches can achieve high reported success, but differing definitions and study methods make apparent differences between techniques difficult to interpret. More consistent outcome reporting would support clearer comparisons and better-informed evaluation of treatment options.

What to keep in mind

Substantial heterogeneity in outcome definitions, study design, subgroup reporting, and follow-up limits direct comparison between techniques.