High Pressure Balloon Dilatation of Primary Obstructive Megaureter in Children: A Multicenter Study

Abstract

Aim of the Study: We described the initial experience of four referral centers in the treatment of primary obstructive megaureter (POM) in children, by high-pressure balloon dilatation (HPBD) of the ureterovesical junction with double JJ stenting. We managed a retrospective multicenter study to assess its effectiveness in long-term.Methods: We reviewed the medical records of all children who underwent HPBD for POM that require surgical treatment from May 2012 to December 2017 in four different institutions. The primary outcome measured was ureterohydronephrosis (UHN) and its degree of improvement after the procedure. Secondary outcomes were postoperative complications and resolution of preoperative symptomatology.Main Results: Forty-two ureters underwent HPBD for POM in 33 children, with a median age of 14.7 months – (range: 3 months −15 years). Ureterohydronephrosis improves in 86% of ureters after one endoscopic treatment. Three cases required a second HPBD. Four patients required surgical treatment for worsening of UHN after endoscopic treatment. The post-operative complication rate was 50% (21 ureters). In 13 cases (61%), they were related to double J stent. The median follow-up was 24 months (2 months −5 years) and all patients were symptom-free.Conclusion: We reported the first multicenter study and the largest series of children treated with HPBD, with an overall success rate of 92%. Endoscopic treatment can be a definitive treatment of POM since it avoided reimplantation in 90% of cases. Complications are mainly due to double J stent.

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

“…POM is described by literature as a congenital dilatation of the ureter due to an adynamic segment at its terminal portion as the result of a disturbed development of the prevesical portion of the ureter [20]; for this reason, the aetiopathogenesis of POM has always been based on a functional defect. In our series we found, during the HPBD, a stenotic ring at the VUJ in 10 (83%) patients, the same result found by Torino in 2013 and Capozza in 2014 (80% and 83% of patients, respectively, with a stenotic ring during HPBD) [16,22].The HPBD technique is described as effective when the ring at the VUJ disappears during the procedure [17,20,21,28], and for some authors the patients who have a ring that disappears during the procedure have a better result at follow-up [16,22].The presence of the ring and its disappearance during HPBD indicates an anatomical cause of the POM rather than a functional cause as described in the literature; for this reason, we suggest a new aetiopathogenetic hypothesis of POM based on an anatomical stricture of the VUJ.…”

“…Endoscopic dilatation or endoureterotomy of the vesicoureteral junction have also been described as valid treatments [13,14]. Endoscopic treatment with high-pressure balloon dilatation (HPBD) was described by Angulo in 1998 [15]; since then several publications have shown that HPBD is a feasible, safe and minimally invasive procedure, even for patients less than 1 year of age [16][17][18][19][20][21][22]. The aim of this study was to describe our experience and the outcomes of the HPBD technique, which, starting from 2018, in our institute has become the first line of treatment for patients with POM.…”

Endoscopic treatment of obstructive ureterohydronephrosis in children

“…Besides the fact that minimal invasive endoscopic treatment is fairly proved as safer for young children as a first step approach, it is not complication-free according to the literature [ 6 ]. Ureteral and bladder injury, poor tolerance of the DJ stent which presents as flank pain, DJ migration which demands repositioning, upper and lower urinary tract infection, vesicoureteral reflux and persistent hematuria are the main complications encountered in the bibliography [ 2 , 6 , 9 ]. In our short series, two of the four children presented febrile urinary tract infection which in the case #1 resolved with IV antibiotics and in case#2 demanded the removal of the DJ catheter.…”

Der Primär Obstruktive Megaureter (POM) – Eine Domäne konservativer Therapie

“…Lebensjahr) ein stabiles Behandlungsergebnis erreicht werden kann [18]. Auch in einer Multicenter-Studie aus Frankreich konnte die Effektivität dieser Behandlung in 50 Fällen nachgewiesen werden [19]. Eine längere Schienung des Harnleiters mittels Doppel-J-Katheter über 3 Monate war jedoch mit keiner Verbesserung des Outcomes verbunden, dagegen mit einem höheren HWI-Risiko postoperativ, sodass eine solche Ableitung allenfalls über einen kürzeren Zeitraum (max.…”