Preliminary application and efficacy evaluation of the modified Lich-Gregoir technique in the management of primary obstructive megaureter.

PURPOSE: To evaluate the clinical efficacy and safety of a modified Lich-Gregoir technique for treating primary obstructive megaureter (POM) in children.

MATERIALS AND

METHODS

Between January 2023 and June 2024, a modified Lich-Gregoir procedure was performed on thirty-eight pediatric patients with POM at two medical centers, using either robot-assisted laparoscopic (RALUR) or laparoscopic ureteral reimplantation (LUR). The core procedural innovation involves creating a new ureteral orifice at the bladder dome, anastomosing the distal ureter to it, and embedding the ureter into the muscular layer of the bladder. Statistical analyses were conducted on several parameters, encompassing imaging features such as distal ureteric diameter and anteroposterior pelvic diameter. Perioperative safety was evaluated using metrics including operation time, estimated blood loss, and complication rates. Postoperative recovery was assessed through the duration of hematuria and the length of the postoperative hospital stay.

RESULTS

All procedures were performed successfully, with no conversions or intraoperative complications. The RALUR group exhibited a shorter intra-abdominal time and a briefer duration of gross hematuria than the LUR group. During follow-up, urinary tract infections were observed in one patient following RALUR and in three patients after LUR. At the six-month postoperative follow-up, both groups exhibited significant decreases in ureteral diameter and anteroposterior pelvic diameter. The procedures achieved a 100 % success rate, with no instances of recurrent obstruction.

CONCLUSION

Our preliminary experience indicates that the modified Lich-Gregoir technique effectively alleviates POM-related ureteral dilation and hydronephrosis, yielding promising results.