Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up?

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery
• Urological Therapeutics

Background:

• Persistent or progressive primary obstructive megaureter (POM) traditionally treated with ureteral tapering and reimplantation, which carries risks of complications and morbidity.
• Endoscopic balloon dilation presents a promising less invasive alternative for POM management.

Purpose of the Study:

• To evaluate the long-term efficacy of endoscopic balloon dilation for treating POM.
• To assess the complication profile associated with this minimally invasive procedure.

Main Methods:

• Retrospective review of 19 patients (20 ureters) treated with endoscopic balloon dilation for POM between June 2000 and February 2010.
• Indications for surgery included persistent obstruction, impaired renal function (<40%), worsening hydronephrosis, febrile UTIs, or renal calculi.
• Procedure involved endoscopic and fluoroscopic guidance with balloon inflation (12-14 atm) and double J stent placement for 2 months.

Main Results:

• A 90% success rate after the first dilation, with one additional success after a second dilation.
• Renal function preserved in 95% of patients with a mean follow-up of 6.9 years.
• No perioperative complications; two patients experienced febrile UTIs, and one developed vesicoureteral reflux.

Conclusions:

• Endoscopic balloon dilation is a safe, feasible, and effective minimally invasive treatment for POM with favorable long-term outcomes.
• While promising, further multicenter studies and prospective trials are recommended to solidify evidence on its benefits.