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

Area of Science:

• Pediatric Urology
• Minimally Invasive Surgery

Background:

• Primary obstructive megaureter (POM) is a congenital condition requiring effective treatment to preserve renal function.
• Traditional surgical approaches for POM can be invasive, prompting research into less invasive alternatives.

Purpose of the Study:

• To evaluate the long-term efficacy, safety, and outcomes of endoscopic balloon dilation (EBD) for primary obstructive megaureter (POM).
• To present the largest reported series of POM treated with EBD.

Main Methods:

• Retrospective analysis of 79 POM cases (73 patients) treated with EBD between 2004 and 2016, with >18 months follow-up.
• EBD of the vesicoureteral junction using high-pressure balloon catheters, followed by Double-J stent placement.
• Follow-up included clinical reviews, ultrasounds, and MAG-3 renograms.

Main Results:

• EBD demonstrated an 87.3% long-term success rate with a mean follow-up of 6.4 years.
• Initial renal function was preserved, with significant improvement in renal drainage (p < 0.001).
• Secondary VUR occurred in 21.5% but was successfully treated endoscopically in 76.4%; 12.2% experienced re-stenosis, with 8/9 successfully re-treated by EBD.

Conclusions:

• Endoscopic balloon dilation (EBD) is an effective first-line treatment for primary obstructive megaureter (POM), offering good long-term outcomes and minimal complications.
• Secondary vesicoureteral reflux (VUR) is the main complication but can be managed effectively with endoscopic subureteral injection.
• EBD is a safe and viable alternative to open surgery for POM.