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Published on: January 7, 2019
Endoscopic balloon dilatation of primary obstructive megaureter: An effective first line management in children
Olugbenga Awolaran1, Ijeoma Nwachukwu1, Anu Paul1
1Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.
Insights
Endoscopic balloon dilatation (EBD) effectively treats primary obstructive megaureter (POM) in children, achieving an 87% success rate after one procedure and 95% after two. This minimally invasive approach is a safe first-line management option for POM.
Area of Science:
- Pediatric Surgery
- Urology
- Minimally Invasive Procedures
Background:
- Primary obstructive megaureter (POM) is a congenital condition affecting the ureter.
- Management options for POM include surgical intervention.
- Endoscopic balloon dilatation (EBD) is a less invasive alternative.
Purpose of the Study:
- To evaluate the outcomes of endoscopic balloon dilatation (EBD) for primary obstructive megaureter (POM) in children.
- To assess the efficacy and safety of EBD as a primary treatment for POM.
Main Methods:
- Retrospective review of data from two UK tertiary pediatric surgical centers (2013-2023).
- Assessment of pre- and post-operative clinical and imaging parameters in children treated with EBD.
- Definition of procedural failure as the need for further intervention due to persistent symptoms or obstruction.
Main Results:
- 55 children (61 renal units) were evaluated with a median follow-up of 24 months.
- Significant reduction in upper tract ultrasound measurements post-EBD; no significant change in renal function.
- 87% success rate after a single EBD, increasing to 95% after a second dilatation; 5% required ureteric re-implantation.
Conclusions:
- EBD is an effective definitive surgical management option for POM in children.
- Success rates are comparable to other studies, with repeat dilatation showing high success.
- EBD can be safely offered as a first-line management for all pediatric POM patient groups.
Aim:
This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children.
Methods:
Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period.
Results:
55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25 mm (p = 0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation.
Discussion:
Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25 mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature.
Conclusions:
This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.
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