High-pressure balloon dilatation for the treatment of primary obstructive megaureter: is it the first line of treatment in children and infants?

Abstract

AIMS OF THE STUDY:To evaluate the efficacy of highpressure balloon dilatation (HPBD) as treatment of primary obstructive megaureter (POM) in paediatric patients, we analysed the data of our institute from June 2018 to September 2019.METHODS: 14 patients, aged 5 months to 5 years, with POM were treated with HPBD. All patients had a distal ureter dilatation greater than 7 mm associated with obstructive features on a mercaptoacetyl triglycine-3 diuretic renogram scan, and a voiding cystourethrogram without vesicoureteral reflux. HPBD was performed in 12 patients, whereas 2 patients (14%), aged 5 and 6 months, required open surgical treatment because of failure to pass the balloon catheter through the vesicoureteral junction. The procedure was performed with a 5 Fr balloon catheter for two cycles of 5 minutes each at 17 atm. A double-J stent and a urinary catheter were inserted at the end of procedure in all patients. RESULTS: No operative complications or symptoms or recurrence were recorded in our series. The patients were generally discharged 24 hours after surgery. All the patients showed an improvement on ultrasonography at the postoperative follow-up, with no evidence of obstruction. During the procedure a clear stenotic ring was identified in 10 of the 12 patients, which disappeared in all 10 cases after the HPBD technique.CONCLUSIONS: Based on our experience, HPBD may be considered the first-line surgical approach in the treatment of POM in children, avoiding bladder surgery in most cases. ABBREVIATIONS: HPBDhigh-pressure balloon dilatation MAG-3 mercaptoacetyl triglycine-3 POM primary obstructive megaureter UTI urinary tract infection VUJ vesicoureteral junction VCUG voiding cystourethrogram

High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

“…1 ). 13 studies were included in the analysis [ 10 – 22 ]. All included studies were retrospective in design.…”

“…Out of 13 studies included, ten reported routinely using a double-J stent for three weeks to 3 months after HPBD [ 10 , 11 , 13 , 15 , 16 , 18 – 22 ]. Two authors [ 12 , 14 ] reported that a double-J was not inserted routinely.…”

“…Out of the 13 studies, five [ 10 , 14 , 19 – 21 ] reported using a single perioperative antibiotics prophylaxis only, while five [ 13 , 15 , 17 , 18 , 22 ] reported continuing antibiotics as chemoprophylaxis after HPBD. Most used prophylaxis until the double- J stent was removed, while Casal Beloy et al [ 13 ] reported continuing antibiotics for only 5 days.…”

Minimally invasive ureteral reimplantation or endoscopic management for primary obstructive megaureter: a narrative review of technical modifications and clinical outcomes

“…The dilating balloon was insufflated until the narrow ring disappeared, and a double-J stent was positioned and withdrawn 2 months after the procedure. Short-term follow-ups have yielded various success rates (46% to 100%) after the first dilatation and rates of hydronephrosis improvement (76% to 100%) (as shown in Table 3 ) ( 58 - 60 , 62 , 64 , 68 , 69 ). Moreover, long-term follow-ups of 6.9 and 10.3 years also present high overall success rates of 95% and 100% respectively ( 63 , 66 ).…”

“…Since EBD of obstructive megaureter was first reported by Angulo et al in 1998 (56), many urologists have published their experiences and outcomes (Table 3) (55,(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69). EBD was traditionally performed under fluoroscopic monitoring.…”