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.