Surgical and Functional Outcomes of a Novel Modified Combined Ureteroneocystostomy Technique in Children

Background: Surgical correction remains the gold-standard treatment for selected children with high-grade vesicoureteral reflux (VUR), and open ureteroneocystostomy achieves long-term success rates exceeding 90%. However, established reimplantation techniques may have specific anatomical and functional limitations, including altered ureteral trajectory, ureteral angulation or kinking, and postoperative voiding dysfunction. In a previous preliminary study, we described a modified combined intravesical–extravesical ureteroneocystostomy technique integrating principles of the modified Politano–Leadbetter and Glenn–Anderson procedures through a hiatus-referenced, double-level submucosal tunnel configuration. The present study evaluates the surgical and functional outcomes of this technique in a larger pediatric cohort. Methods: This retrospective cohort study included 75 consecutive pediatric patients, corresponding to 118 renal units, who underwent modified combined intravesical–extravesical ureteroneocystostomy at a single tertiary center between January 2020 and August 2025. Sixty patients underwent surgery for primary VUR and 15 for primary obstructive megaureter. The primary outcome was surgical success, defined as the absence of persistent or recurrent reflux, clinically significant ureterovesical junction obstruction, reoperation, and febrile urinary tract infection. Results: Minimum follow-up was 12 months, with a median follow-up of 24 months (range, 12–60 months). Patient-based surgical success was 93.3% in both the primary VUR group (56/60) and the obstructive megaureter group (14/15). Renal unit-based success was 95.8% (113/118). Persistent, recurrent, or de novo postoperative VUR was identified in five renal units (4.2%). No febrile urinary tract infection, clinically significant ureterovesical junction obstruction, urinary retention, persistent postoperative voiding dysfunction, or reoperation was recorded during follow-up. No Clavien–Dindo grade III or higher complications occurred. Conclusions: The modified combined intravesical–extravesical ureteroneocystostomy technique demonstrated high surgical success and a favorable safety profile in children with primary VUR and selected cases of primary obstructive megaureter during intermediate-term follow-up. Its hiatus-referenced tunnel configuration is intended to maintain a more physiological ureteral trajectory while distributing the submucosal tunnel both cranially and caudally relative to the original hiatus. Prospective multicenter studies with standardized postoperative reflux assessment and longer follow-up are needed to confirm reproducibility and durability.