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Published on: January 7, 2019
Endoscopic management and the role of double stenting for primary obstructive megaureters
Matthew S Christman1, Sanjay Kasturi, Sarah M Lambert
1Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Endoscopic incision and balloon dilation with double stenting effectively treated primary obstructive megaureter in children, offering an alternative to surgery. This minimally invasive approach showed symptom-free outcomes and stable imaging for at least two years post-procedure.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Primary obstructive megaureter is a congenital condition requiring intervention.
- Traditional surgical repair (reimplantation) carries risks and longer recovery.
- Endoscopic techniques offer a less invasive alternative for pediatric urological conditions.
Purpose of the Study:
- To evaluate the efficacy of endoscopic incision and balloon dilation with double stenting.
- To assess potential complications of this endoscopic approach.
- To determine its suitability for treating primary obstructive megaureter in children.
Main Methods:
- Prospective review of 17 pediatric patients with primary obstructive megaureter.
- Endoscopic procedures included balloon dilation and/or laser incision based on segment length.
- Placement of two ureteral stents for 8 weeks, followed by imaging at 3 months and 2 years.
Main Results:
- Significant improvement in hydroureteronephrosis observed in 12 patients via ultrasound.
- Remaining 5 patients showed improvement, with MRI confirming no obstruction.
- All patients were symptom-free with stable imaging at a minimum 2-year follow-up.
Conclusions:
- Endoscopic management is a viable alternative to reimplantation for primary obstructive megaureter with short narrowed segments (<3 cm).
- Double stenting appears effective in maintaining neo-orifice patency.
- Long-term follow-up into adolescence is recommended to confirm sustained outcomes.
Purpose:
We determined the efficacy and potential complications of endoscopic incision and balloon dilation with double stenting for the treatment of primary obstructive megaureter in children.
Materials And Methods:
We prospectively reviewed cases of primary obstructive megaureter requiring repair due to pyelonephritis, renal calculi and/or loss of renal function. A total of 17 patients were identified as candidates for endoscopy. Infants were excluded from study. All patients underwent cystoscopy and retrograde ureteropyelography to start the procedure. In segments less than 2 cm balloon dilation was performed, and for those 2 to 3 cm laser incision was added. Two ureteral stents were placed within the ureter simultaneously and left indwelling for 8 weeks. Imaging was performed 3 months after stent removal and repeated 2 years following intervention.
Results:
Mean patient age was 7.0 years (range 3 to 12). Of the patients 12 had marked improvement of hydroureteronephrosis on renal and bladder ultrasound. The remaining 5 patients had some improvement on renal and bladder ultrasound, and underwent magnetic resonance urography revealing no evidence of obstruction. All patients were followed for at least 2 years postoperatively and were noted to be symptom-free with stable imaging during the observation period.
Conclusions:
Endoscopic management appears to be an alternative to reimplantation for primary obstructive megaureter with a narrowed segment shorter than 3 cm. Double stenting seems to be effective in maintaining patency of the neo-orifice. Followup into adolescence is needed.
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