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Endoscopic Balloon Dilatation as a Diagnostic and Therapeutic Tool for Primary Obstructive Megaureter. 10 Year
Jarne Michielsen1, Quinten Bogaerts1, Koenraad van Hoeck2
1Master of Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Insights
Endoscopic balloon dilation (EBD) is a successful treatment for primary obstructive megaureters in children, with a 93.5% success rate. This minimally invasive procedure offers diagnostic information and is recommended for symptomatic cases or declining renal function.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Primary obstructive megaureter (POM) is a congenital condition requiring intervention in select cases.
- Indications for intervention include increasing hydroureteronephrosis, differential renal function <40%, or symptoms.
- Spontaneous resolution of POM is common, necessitating careful patient selection for treatment.
Purpose of the Study:
- To evaluate the 10-year experience with endoscopic balloon dilation (EBD) for primary obstructive megaureters.
- To assess the efficacy and outcomes of EBD in pediatric patients with POM.
- To determine the diagnostic value of EBD regarding ureteral obstruction length.
Main Methods:
- Retrospective review of 31 dilated ureters in 28 patients treated with EBD over 10 years.
- EBD involved inserting a coronary dilatation balloon via cystoscope and inflating it to 15 ATM.
- Patients received a Double-J stent for 6 weeks post-procedure; outcomes included ureteral diameter, DRF, obstruction length, and complications.
Main Results:
- EBD was successful in 29/31 ureters (93.5%).
- Success rates were higher for narrow ring obstructions (96.6%) compared to longer narrow distal ureters (50%).
- EBD provided diagnostic information on the length of the narrow ureteral segment.
Conclusions:
- EBD with a coronary dilatation balloon is a highly successful treatment for primary obstructive megaureters.
- Strong indications for EBD include symptomatic patients and those with declining differential renal function.
- While effective, longer narrow ureteral segments present a higher failure rate.
Abstract:
Purpose: To describe our 10-year experience with EBD for primary obstructive megaureter. Materials and Methods: Children needing intervention for primary obstructing megaureters (POM) (based on increasing distal dilatation >1.4 cm, differential renal function [DRF] <40%, or symptoms) were counseled to undergo a trial of EBD. A 9.5Fr cystoscope and stent "pusher" were used to insert a 14'' guidewire to allow insertion of a 4/25 mm coronary dilatation balloon that was insufflated to 15 ATM for 5 minutes. Afterwards a 4.7Fr Double-J stent was positioned for 6 weeks. Ureteral diameter, DRF, length of obstruction, and complications were registered. Success was defined as improvement of the indication without further need for a more invasive procedure. Results: A total of 31 dilated ureters in 28 patients (23/5 M/F) were included, with a median age of 9 months (M) (range: 1-111) and a follow-up of 41 M (range: 12-84). EBD showed a narrow ring in 29 (93.5%) and longer narrow distal ureters in 2 (6%). EBD was successful in 29/31 ureters (93.5%), with different success rates for a narrow ring (96.6%) and a longer narrow distal ureter (50%). Conclusion: As most POM resolve spontaneously, hard indications are needed before treatment is offered. Symptomatic patients (e.g., infections) and declining DRF with dilated ureters are strong indications. In such cases, EBD with a coronary dilatation balloon has a high success rate and provides diagnostic information regarding the length of the narrow ureteral segment. Longer narrow ureteral segments are rare but result in a higher failure rate.
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