Cohen vs Modified Glenn-Anderson Reimplantation Show Comparable Long-Term Efficacy for POM

This single-center retrospective cohort study (2007-2021) compared the long-term efficacy and safety of Cohen versus modified Glenn-Anderson pneumovesicoscopic ureteral reimplantation for primary obstructive megaureter (POM) in children and defined the learning curves for both procedures. The study included 75 children (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) was also performed to establish a benchmark success rate.

After a mean follow-up of 99.0 months for the Cohen group and 75.7 months for the modified Glenn-Anderson group, reoperation-free rates were 92.6% and 95.8%, respectively (P > 0.05). There were no significant differences in complication rates or functional improvement between the two techniques. CUSUM analysis indicated a learning phase of 22 cases for the Cohen technique and 19 cases for the modified Glenn-Anderson technique, with operative time decreasing by over 30% upon mastery. The meta-analysis yielded a pooled reoperation-free rate of 99.4%.

The study concludes that both techniques demonstrate comparable long-term safety and efficacy for POM, with the modified Glenn-Anderson technique offering a valid alternative that preserves the ureter's anatomical course. Achieving procedural proficiency requires approximately 20 cases. While global success rates are high, the authors note that long-term follow-up is crucial for detecting late complications.

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.