For children born with a condition where the tube from the kidney to the bladder is blocked, surgery is often needed. Doctors have two main minimally invasive surgical techniques to fix it: the Cohen procedure and the modified Glenn-Anderson procedure. Parents naturally want to know which one is better for their child in the long term. This study looked back at 75 children who had one of these surgeries and followed them for an average of over six years. It found that both techniques were equally successful. The chance of a child needing a second surgery was very low and similar for both groups—about 93% for Cohen and 96% for modified Glenn-Anderson. Complication rates and improvement in kidney function were also comparable. The study also showed that for a surgeon to master either technique, they need to perform it about 20 times. After that, the surgery time drops by over 30%. A review of other studies worldwide confirmed that success rates for these surgeries are extremely high overall. The main conclusion is that both are excellent options, but children need long-term check-ups to watch for any rare, late issues.
Two surgical approaches for a childhood kidney condition show similar long-term success.
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What this means for you:
Two surgical fixes for a blocked ureter in kids work equally well, but surgeons need practice to master them. What this means for you:
Two surgical fixes for a blocked ureter in kids work equally well, but surgeons need practice to master them. View Original Abstract ↓
OBJECTIVE: To compare the long-term efficacy and safety of Cohen versus modified Glenn-Anderson pneumovesicoscopic ureteral reimplantation and to define the learning curves for both procedures.
METHODS: A single-center retrospective cohort study (2007-2021) included 75 children with primary obstructive megaureter (POM) (Cohen: n = 27; modified Glenn-Anderson: n = 48). Primary outcomes were reoperation rates and ureteral recovery (diameter < 7 mm) during long-term follow-up. Cumulative sum (CUSUM) analysis was used to model learning curves based on operative time. A meta-analysis of 10 studies (529 patients) established a benchmark success rate.
RESULTS: After a mean follow-up of 99.0 (Cohen) and 75.7 (modified Glenn-Anderson) months, reoperation-free rates were 92.6% and 95.8%, respectively (P > 0.05), with no significant differences in complication rates or functional improvement. CUSUM analysis indicated a learning phase of 22 cases for Cohen and 19 cases for modified Glenn-Anderson, with operative time decreasing by over 30% upon mastery. The meta-analysis yielded a pooled reoperation-free rate of 99.4%.
CONCLUSIONS: Both techniques demonstrate comparable long-term safety and efficacy for POM. The modified Glenn-Anderson technique offers a valid alternative that preserves the ureter's anatomical course. Achieving procedural proficiency requires approximately 20 cases. While global success rates are high, long-term follow-up is crucial for detecting late complications.