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

PURPOSE: Multiple endoscopic treatments for vesicoureteral junction obstruction (VUJO) in children with primary obstructive megaureter (POM) have been described, but their relative effectiveness remains unclear. This systematic review aimed to evaluate the efficacy, safety, and reported outcomes of these techniques. METHODS: A systematic review of MEDLINE via PubMed, Embase, and the Cochrane Library was performed in accordance with PRISMA guidelines (PROSPERO: CRD42024536020). Studies reporting outcomes of endoscopic treatment of VUJO in children were included. The primary outcome was treatment success according to each study's prespecified definition. Procedural success was analyzed separately as a secondary technical feasibility outcome. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis of proportions was performed where outcome definitions were comparable. RESULTS: Twenty-seven studies, including 789 children and 816 renal units, were included. Seven endoscopic strategies were identified. Reported treatment success ranged from 26% to 100%, with nine different definitions identified. Post-operative ureteric reimplantation was most frequent after stenting alone (53.7%), compared with 2.1%-20% across distal ureter-modifying techniques. Balloon dilatation with stenting was the most frequently reported technique (16 studies). Meta-analysis showed definition-specific pooled treatment success ranging from 0.84 to 0.95 for balloon dilatation with stenting and from 0.91 to 1.00 for VUJ incision with stenting, with low statistical heterogeneity in each analysis. Reported complications were mainly stent-related. CONCLUSIONS: Certain endoscopic techniques appear effective in selected children with POM. However, substantial heterogeneity in outcome definitions, study design, subgroup reporting, and follow-up limits direct comparison between techniques. Development of a core outcome set would improve future comparative research.