Vesicoscopic Leadbetter-Politano Ureteral Reimplantation of Primary Obstructive Megaureters in Children Compared to Open Surgery

Background: Minimally invasive surgery in intravesical ureteral reimplantation has proven to be safe and successful in patients with vesicoureteral reflux. This study investigates a novel application of the Leadbetter-Politano procedure for primary obstructive megaureter, focusing on specific challenges in vesicoscopic reimplantation of ureters with large diameters in pediatric patients. Methods: Between 2010 and 2024, 26 children underwent ureteral reimplantation according to Leadbetter-Politano without tapering for primary obstructive megaureter in our clinic. A total of 12 children were operated on vesicoscopically, 14 patients were operated on open-surgically. This retrospective single-center case-control study compares open and vesicoscopic groups with regard to perioperative data and postoperative course. Results: All vesicoscopic Leadbetter-Politano reimplantations started were performed safely, even in young infants of 6 months. The operation time was longer for vesicoscopy (vesicoscopic: 149 minutes, open: 119 minutes, P = .013). Furthermore, vesicoscopic patients had a shorter hospital stay (vesicoscopic: 4.8 days, open: 10.4 days, P < .001), as well as a lower need for continuous analgesic administration (vesicoscopic: 0.5 days, open: 3.8 days, P < .001). There was no extravasation, recurrence, or postoperative vesicoureteral reflux found in any patient. Conclusions: The vesicoscopic Leadbetter-Politano procedure proves to be feasible in reimplantation of primary obstructive megaureter, even in very young infants. Reduced need for pain medication, shorter bladder drainage, and faster mobilization, and thus shorter hospital stay, show that this method offers major advantages to patients at an equivalent success rate compared to its open counterparts.