Severe Primary Obstructive Megaureter in the First Year of Life: Preliminary Experience With Endoscopic Balloon Dilation

Torino, Giovanni; Collura, Giuseppe; Mele, Ermelinda; Garganese, Maria Carmen; Capozza, Nicola

doi:10.1089/end.2011.0399

Cited by 33 publications

(17 citation statements)

References 29 publications

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“…In 2007, Angerri et al ( 4 ) reported their initial experience with 6 patients in whom urinary obstruction disappeared without associated complications in a median follow-up of 31 months. Torino et al ( 5 ) presented 5 cases treated below 1 year of age, with resolution of the obstruction after a mean follow-up of 23.8 months. Christman et al ( 6 ) reported in 2012 their experience after the treatment of 17 children with a follow-up of 3.2 years.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Primary Obstructive Megaureter Treated by Endoscopic Balloon Dilation. Experience After 100 Cases

et al. 2018

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Aim: To assess long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation (EBD) in the largest series reported.Patients and Methods: Hundred POM in 92 consecutive patients were treated by EBD between years 2004 and 2016. A total of 79 POM (73 patients) with more than 18 months of follow-up after treatment have been analyzed. EBD of the vesicoureteral junction was performed with semicompliant high-pressure balloon catheters (2.7FG) with minimum balloon diameter of 5 mm, followed by temporary Double-J stent placement. Follow-up protocol included periodical clinical reviews, US and MAG-3 renogram scans.Results: Median age at surgery was 4 months (15 days−3.6 years), with median operating time of 20 min (10–60) and hospital stay of 1 day (1–7). Initial renal function was preserved in all patients with significant improvement in renal drainage on the MAG-3 diuretic renogram after endoscopic treatment (p < 0.001 T-test). Significant post-operative differences were observed in hydronephrosis grade and ureteral diameter that were maintained in the long-term (p < 0.001 T-test). Endoscopic approach of POM had a long-term success rate of 87.3%, with a mean follow-up of 6.4 ± 3.8 years. Secondary VUR was found in 17 cases (21.5%), being successfully treated by endoscopic subureteral injection in 13 (76.4%). Nine cases developed long-term re-stenosis (12.2%) that were successfully treated with a new EBD in 8. Endoscopic management of POM failed in 10 cases (12.7%) that required ureteral reimplantation. Five were early failures (4 intraoperative technical problems and 1 double-J stent migration with severe re-stenosis), and 5 long-term (4 persistent VUR and 1 re-stenosis recurrence).Conclusion: EBD has shown to be an effective treatment of POM with few complications and good outcomes at long-term follow up. Main complication was secondary VUR that could also be treated endoscopically with a high success rate. In our opinion, EBD may be considered first-line treatment in POM.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Primary Obstructive Megaureter Treated by Endoscopic Balloon Dilation. Experience After 100 Cases

et al. 2018

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“…32 Endoscopic balloon dilation is suggested by some clinicians as a minimally invasive therapy in patients less than 1 year old who have POMU. 13,33 This procedure, however, is not without its complications. As Garcia-Aparicio and associates 33 pointed out, 3 of 13 patients needed ureteral reimplantation because of persistent hydroureteronephrosis and VUR.…”

Section: Discussionmentioning

confidence: 99%

“…It may create iatrogenic vesicoureteral reflux (VUR), as well. 12,13 Reimplantation of an obstructed megaureter should be avoided in the first year of life. because it has a higher failure rate as well as a greater risk of morbidity and reoperation.…”

Section: Introductionmentioning

confidence: 99%

Result of Endoureterotomy in the Management of Primary Obstructive Megaureter in the First Year of Life: Preliminary Report

Shirazi

Natami

Hekmati

et al. 2014

Journal of Endourology

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“…The balloon catheter, originally designed for angioplasty, is currently used by our team for the treatment of obstructive megaureter [4]. It has a caliber of 3,8 French; the balloon can be in lated with contrast medium up to a diameter of 4 mm (patients 6 -24 months of age) to 6 mm (over 2 years) and up to a pressure of 12 atmospheres.…”

Section: Methodsmentioning

confidence: 99%

Persistent hydronephrosis after pyeloplasty: Is it a true obstruction? The role of endourology

Mele¹,

Innocenzi²,

Prete³

et al. 2020

J Clini Nephrol

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Introduction:Anderson-Hynes pyeloplasty remains the gold standard in the treatment of ureteropelvic junction obstruction. The diagnostic criteria for defi ning the failure of pyeloplasty are not well-defi ned or even arbitrary. Likewise, the ideal treatment of persistent hydronephrosis after pyeloplasty is not well established. We tested an innovative endourological procedure, which simultaneously allows a diagnostic defi nition of failure and treatment when necessary. Materials and methods:The endourological procedure was applied prospectively to 13 cases from 2006 to 2015. The mean hydronephrosis was 3 cm and all the patients showed an obstructive pattern at scintigraphie. Of these, only 2 patients had symptoms. The procedure consisted in the endoscopic calibration of the pyeloureteral junction. In case of confi rmed persistent stenosis, the procedure continued with the high pressure dilation of the junction. The calibration/dilation procedure was carried out with a balloon catheter, previously used for high pressure dilation in the obstructive megaureter. In all patients, a ureteral stent was positioned for 6 -8 weeks.The patients were then followed up using ultrasound and renoscintigraphie.Results: According to the endoscopic balloon procedure, anastomosic stenosis was confi rmed in 3 cases, treated with high pressure dilation during the same procedure. In 10 cases no stenosis was found and we followed-up these patients with periodic ultrasound and scintigraphie. Conclusion:The calibration/dilation of the pyeloureteral junction represents in our opinion a useful diagnostic and therapeutic tool that allows to limit the repetition of open surgery only to symptomatic cases and those non-responders to endoscopic treatment.

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Severe Primary Obstructive Megaureter in the First Year of Life: Preliminary Experience With Endoscopic Balloon Dilation

Cited by 33 publications

References 29 publications

Long-Term Outcomes in Primary Obstructive Megaureter Treated by Endoscopic Balloon Dilation. Experience After 100 Cases

Long-Term Outcomes in Primary Obstructive Megaureter Treated by Endoscopic Balloon Dilation. Experience After 100 Cases

Result of Endoureterotomy in the Management of Primary Obstructive Megaureter in the First Year of Life: Preliminary Report

Persistent hydronephrosis after pyeloplasty: Is it a true obstruction? The role of endourology

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