Endoureterotomy for Treatment of Primary Obstructive Megaureter in Children

Abstract

On the basis of previous studies demonstrating the value of endoureterotomy with stenting for the treatment of benign ureteral strictures in adults, we developed a modified endoscopic approach for the treatment of POMU and applied this technique in meticulously selected cases. Our results showed that this approach is a valid option for the treatment of children with POMU.

The utilization of stents in the management of primary obstructive megaureters requiring intervention before 1 year of age

“…A temporary cutaneous ureterostomy is an alternative option, though not without its complications, which include stomal stenosis and pyelonephritis [21]. Kajbafzadeh et al [22] described an endoureterotomy procedure in patients with 'intravesical ureteral obstruction' and a stricture length < 1.5 cm. Their case series of 47 patients includes infants as young as 1.5 months, although mean age at intervention was 3.7 years.…”

Miniature pyeloplasty as a minimally invasive surgery with less than 1 day admission in infants

“…Minor complications were observed in 30 patients, including asymptomatic bacteriuria (non-febrile UTI) in 16 patients, ureterovesical junction obstruction in 3 and mild hematuria in 11 patients. Since the Double J stent did not pass through the ureterovesical junction, two patients were managed by endoscopic endoureterotomy at the same session [11], and one was managed by ureteric reimplantation 3 months after pyeloplasty. Asymptomatic UTIs resolved after removal of the Double J and hematuria was treated conservatively.…”

Concomitant Endoureterotomy and Dextranomer/Hyaluronic Acid Subureteral Injection for Management of Obstructive Refluxing Megaureter

“…The criteria for performing the modified technique were the presence of intravesical ureteral obstruction, a stricture length of < 1.5 cm, and proportionally shorter cutoff points with regard to the individual ureteral length and age based on our previous experience in children with primary obstructive megaureter. 2 The ureterovesical junction was dilated by passing a 3F Double-J stent over the guidewire through the ureteral orifice. In cases with a narrow ureteral orifice, a 1F guidewire was advanced through the ureterovesical junction followed by the 3F Double-J stent.…”

“…Reflux is usually attributed to the nonfunctional anatomic association of the ureters and the bladder. 2,3 Diagnosis of the PORM is important because the treatment of the obstructive pattern differs from the reflexive pattern alone. The diagnosis is usually based on a dilated ureter, smooth tapering of the lower ureter, refluxing pattern on voiding cystourethrography (VCUG), and ruling out the infravesical or extrinsic obstructions.…”

“…Our previous report on endoureterotomy for primary obstructive megaureter was promising. 2 The present study reviewed our experience with combined endoureterotomy and endoscopic injection of dextranomer/ hyaluronic acid (Deflux Ò ) for the treatment of PORM with long-term follow-up.…”