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High pressure balloon dilatation of the ureterovesical junction in primary obstructive megaureter: Infectious
Introduction:
The objective of this study is to investigate the infectious morbidity associated with high-pressure balloon dilatation (HPBD) and an indwelling double J stent, in primary obstructive megaureter.
Methods:
We reviewed the cases of 12 patients undergoing endoscopic treatment for primary obstructive megaureter from January 2012 to January 2015. The characteristics of the infection and data concerning the patient and the intervention were analyzed.
Results:
The frequency of preoperative urinary tract infection (UTI) was 58%. The procedure was feasible in 100% of cases. Two patients required a second dilatation. One patient underwent Cohen's ureteral reimplantation after failure of the second dilatation. The frequency of postoperative UTI was 25%. All these infections occurred in patients with a double J stent. None of the patients had UTI after stent removal. None of the patients developed postoperative vesicoureteral reflux (VUR) after HPBD.
Conclusion:
Endoscopic balloon dilatation has been shown to have good short- mid- and long-term outcomes. In our experience, the morbidity of this procedure mostly results from infections, exclusively related to the use of a double J stent. The placement of a double J stent has a significant medical and economic impact. A definitive decision about the utility of double J stents will require studies of further dilatation without the placement of a double J stent.
Level Of Evidence:
4.
Insights
High-pressure balloon dilatation (HPBD) for primary obstructive megaureter is effective, but postoperative urinary tract infections (UTIs) are linked to double J stents. Further research is needed to assess stent necessity.
Area of Science:
- Urology
- Endourology
- Pediatric Surgery
Background:
- Primary obstructive megaureter is a condition requiring effective treatment.
- Endoscopic approaches offer minimally invasive options for managing obstructive megaureter.
Purpose of the Study:
- To evaluate infectious morbidity associated with high-pressure balloon dilatation (HPBD) and double J stents in primary obstructive megaureter.
- To assess the safety and efficacy of HPBD as an endoscopic treatment.
Main Methods:
- Retrospective review of 12 patients with primary obstructive megaureter treated between January 2012 and January 2015.
- Analysis of patient characteristics, intervention details, and infectious complications post-HPBD.
Main Results:
- High-pressure balloon dilatation (HPBD) was feasible in 100% of cases.
- Postoperative urinary tract infection (UTI) occurred in 25% of patients, exclusively those with indwelling double J stents.
- No UTIs were observed after double J stent removal, and no postoperative vesicoureteral reflux (VUR) developed.
Conclusions:
- Endoscopic balloon dilatation demonstrates favorable short- to long-term outcomes for primary obstructive megaureter.
- Infectious complications are primarily associated with the use of double J stents, highlighting their significant medical and economic impact.
- Further studies are warranted to determine the necessity of double J stents in conjunction with dilatation procedures.
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