Abstract：
The megaureter accounts for almost a quarter of all urinary tract dilations diagnosed in utero and is the second leading cause of hydronephrosis in newborns, following pyeloureteral junction obstruction. The current standard treatment for progressive or persistent, symptomatic primary obstructive megaureter is ureteral anti-reflux reimplantation, which can be associated with ureteral remodeling or plication. Due to the associated morbidity, postoperative recovery challenges, and the complications that may arise from the open surgical approach, there has been a natural inclination towards validating new minimally invasive techniques. This study reviews the literature, extracting data from three major international databases, from 1998 to 2022. Out of 1172 initially identified articles, only 52 were deemed eligible, analyzing 1764 patients and 1981 renal units. Results show that 65% of cases required surgical intervention, with minimally invasive techniques constituting 56% of these procedures. High-pressure endoscopic balloon dilation was the preferred endourologic technique. The degree of ureterohydronephrosis is considered one of the factors indicating the need for surgery. There is an inverse relationship between the diameter of the ureter and the likelihood of spontaneous resolution. Conditions such as renal hypoplasia, renal dysplasia, or ectopic ureteral insertion strongly indicate a poor prognosis. Endoscopic surgical techniques for treating primary obstructive megaureter can be definitive, firstline treatment options. In selected cases, they might be at least as effective and safe as the open approach, but with advantages like quicker recovery, fewer complications, shorter hospital stays, and reduced costs.
摘要：
在子宫内诊断的所有尿路扩张中，巨输尿管占几乎四分之一，是新生儿肾积水的第二大原因，肾盂输尿管交界处梗阻后。目前的标准治疗为进行性或持续性，有症状的原发性梗阻性巨输尿管是输尿管抗反流再植入，这可能与输尿管重塑或折叠有关。由于相关的发病率，术后恢复的挑战，以及开放手术方法可能引起的并发症，人们自然倾向于验证新的微创技术。本研究回顾了文献，从三个主要的国际数据库中提取数据，从1998年到2022年。在最初确定的1172篇文章中，只有52人被视为合格，分析1764例患者和1981例肾脏单位。结果显示65%的病例需要手术干预,微创技术占这些程序的56%。高压内窥镜球囊扩张术是首选的腔内技术。输尿管积水的程度被认为是表明需要手术的因素之一。输尿管的直径与自发消退的可能性之间存在反比关系。比如肾发育不全,肾发育不良,或输尿管异位插入强烈表明预后不良。用于治疗原发性阻塞性巨输尿管的内窥镜手术技术可以是确定的，一线治疗选择。在某些情况下，它们可能至少和开放方法一样有效和安全，但是有更快恢复的优势，并发症少,缩短住院时间,并降低成本。
