Introduction: Safe initial surgery is crucial in treating ectopic ureteroceles that cause subvesical obstruction. This study evaluates the feasibility and effectiveness of pneumovesicoscopic incision of ectopic ureteroceles. Methods: We conducted a cohort study analyzing outcomes in patients with ectopic ureteroceles and bladder neck obstruction who underwent pneumovesicoscopic surgery between 2013 and 2022. During vesicoscopy, the obstructing portion of the ureterocele adjacent to the bladder neck was resected. Postoperatively, patients were assessed for vesicoureteral reflux and voiding dysfunction. Results: Fourteen patients aged 0–10 years underwent the procedure safely. Ten girls presented with duplex kidneys, and four boys had single moieties. The mean operative time was 57 min. Postoperative resolution of subvesical obstruction was achieved in all cases (100 %). The median follow-up was 5.9 years. Preoperative voiding dysfunction, observed in nine patients, improved in all and completely resolved in four. Conclusion: The pneumovesicoscopic approach appears to be a safe and effective surgical option for pediatric patients with obstructive ureteroceles.