Comparison of cohen procedure and modified intravesical detrusorrhaphy technique in the treatment of obstructive or refluxive megaureters: A prospective comparative study

Background Megaureter, either obstructive or refluxing in nature, is a common urological condition in pediatric patients that often requires surgical intervention. Ureteral reimplantation is the standard treatment when conservative management fails, with the Cohen cross-trigonal technique being the most widely adopted approach due to its reliability and established success rates. However, alternative techniques, such as modified intravesical detrusorrhaphy (MDR), are being explored to potentially reduce complications and improve outcomes. Objective This prospective comparative study aimed to compare the efficacy and outcomes of the Cohen procedure and the modified intravesical detrusorrhaphy (MDR) technique in the surgical management of pediatric patients with obstructive or refluxing megaureter. Study design A total of 44 patients diagnosed with obstructive or refluxing megaureter were randomly assigned to undergo either the Cohen (n = 22) or MDR (n = 22) procedure based on order of presentation. Demographic data, imaging results (VCUG, DTPA, DMSA), and ultrasonography findings were collected preoperatively. Intraoperative parameters (operation time, complications) and postoperative outcomes (catheter and drain removal time, short- and medium-term follow-up imaging) were assessed and compared between the groups. Postoperative imaging included ultrasonography at 1 week and 1 month, and VCUG at 6 months. Results The study cohort included 22 males and 22 females, with a mean age of 5.00 +/- 3.76 years (range: 1-16). Surgical indications were obstructive megaureter in 18 patients (40.9 %) and refluxive megaureter in 26 (59.1 %). There was no statistically significant difference in mean operation times or complication rates between the two groups (p > 0.05). During medium-term follow-up, recurrent VUR was detected in one patient from each group. Discussion Both the Cohen and MDR techniques demonstrated comparable efficacy and safety in treating pediatric megaureter. The similarity in outcomes, including complication and recurrence rates, suggests that MDR may be a viable alternative to the more established Cohen procedure, especially when individualized surgical considerations are taken into account. Conclusion Ureteral reimplantation remains a highly successful intervention for megaureter. This study supports the use of both the Cohen and MDR techniques, with MDR offering comparable results, thereby expanding the surgical options available for managing this condition.

Journal

JOURNAL OF PEDIATRIC UROLOGY

Year

2026

Volume

22

Issue

1

ISSN

1477-5131

eISSN

1873-4898

DOI

10.1016/j.jpurol.2025.11.008

WoS UID

WOS:001696290000022