Comparative Outcomes of Primary Ureteral Reimplantation Versus Staged Cutaneous Ureterostomy in Infants Under One with Primary Obstructive Megaureters and Vesicoureteral Reflux: A Multi-Center Analysis

Purpose: This study evaluates the management and long-term outcomes of pediatric patients under one year of age with primary obstructive megaureters (POM) and vesicoureteral reflux (VUR), comparing primary ureteral reimplantation (PR) to a two-stage approach involving cutaneous ureterostomy (CU) followed by reimplantation. Methods: A multi-institutional study was conducted between 1994 and 2024, including 28 pediatric patients under 12 months of age. Participants were divided into two groups: PR (n=14) and CU (n=14). Comprehensive preoperative assessments, including renal ultrasound, voiding cystourethrography, and radionuclide diuretic renal scans, were performed. Surgical indications were based on recurrent UTIs, impaired renal function, or progressive hydronephrosis. Results: No significant difference in hydroureteronephrosis grade (SFU) was observed between the two groups (p < 0.05). In the PR group, two children required additional surgeries due to recurrent UTIs. Similarly, in the CU group, two children underwent subsequent ureteral reimplantation. The mean age at primary surgery was 6.9 months for the PR group, compared to 4 months for ureterostomy in the CU group (p < 0.05). The average operation time was 110.5 minutes for PR, versus 64 minutes for CU (p < 0.05). Overall, more complications occurred in the group of children with CU until a definitive repair was performed. Conclusions: Both primary ureteral reimplantation and the two-stage approach with cutaneous ureterostomy followed by reimplantation demonstrated effective outcomes in managing POM and VUR in infants. Given the findings, primary ureteral reimplantation may be considered a safe and effective approach in infants under one year old with these conditions.