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High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

Liisi Ripatti1, Hanna-Reeta Viljamaa2, Anna Suihko2

  • 1Department of Pediatric Surgery, Turku University Hospital, Savitehtaankatu 5, PL 52, 20520, Turku, Finland. liisi.ripatti@tyks.fi.

BMC Urology
|March 3, 2023
PubMed

Insights

Endoscopic high-pressure balloon dilatation (HPBD) effectively treats primary obstructive megaureter (POM) in children, reducing ureteral and renal pelvis diameters. This safe first-line treatment shows promising outcomes, even in infants, though further comparative studies are needed.

Area of Science:

  • Pediatric Urology
  • Minimally Invasive Surgery
  • Endourology

Background:

  • Primary obstructive megaureter (POM) is a congenital condition requiring effective treatment in children.
  • Endoscopic high-pressure balloon dilatation (HPBD) is an emerging minimally invasive option for POM.
  • Evidence regarding HPBD effectiveness and safety, particularly in infants, requires systematic evaluation.

Approach:

  • A systematic review followed PRISMA guidelines to assess literature on HPBD for pediatric POM.
  • Included studies reported on HPBD's effectiveness in relieving obstruction and reducing hydroureteronephrosis.
  • Complication rates and outcomes, especially in children under one year, were secondary outcomes.

Key Points:

  • HPBD significantly reduced ureteral diameter (15.8mm to 8.0mm) and renal pelvis anteroposterior diameter (16.7mm to 9.7mm).
  • Success rates were 71% after one HPBD and 79% after two HPBD, with a median follow-up of 3.6 years.
  • Overall complication rate was 33%, with no severe (Clavien-Dindo IV-V) complications; postoperative infections (12%) and VUR (7.8%) were noted. Outcomes in infants appeared similar to older children.

Conclusions:

  • HPBD is a safe and effective first-line treatment for symptomatic pediatric POM.
  • Further comparative studies are necessary to confirm long-term outcomes and treatment effects in infants.
  • Identifying specific patient subgroups who will benefit most from HPBD remains a clinical challenge.
Abstract

Keywords:
EndoscopicHydroureteronephrosisInfantPOMTreatment

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