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Retrograde ureteroplasty using balloon dilatation in children with pelviureteric obstruction
1Paediatric Surgical Center, Ibn Sina Hospital, Kuwait.
Insights
Balloon dilatation offers a simple, effective treatment for pediatric pelviureteric junction obstruction (PUJ), with short hospital stays and improved drainage. This minimally invasive approach shows promising long-term results for children with PUJ obstruction.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
Background:
- Pelviureteric junction obstruction (PUJ) is a common cause of hydronephrosis in children.
- Traditional surgical interventions can be invasive and require prolonged hospitalization.
Purpose of the Study:
- To evaluate the efficacy and safety of balloon dilatation for treating congenital and acquired pelviureteric junction obstruction (PUJ) in children.
- To assess the outcomes of retrograde ureteroplasty using balloon dilatation without stenting.
Main Methods:
- Eleven children (12 renal units) with PUJ obstruction underwent balloon dilatation using a Fogarty/Gruntzig catheter via cystoscope.
- No stents were used post-procedure.
- Follow-up extended up to 4.5 years.
Main Results:
- Improved drainage and renal function were observed in all treated renal units.
- Uncomplicated cases had a 1-day hospitalization period.
- One case of acute obstruction in a solitary kidney required temporary percutaneous nephrostomy.
- Macroscopic hematuria occurred in one case, necessitating a 3-day hospital stay.
Conclusions:
- Retrograde ureteroplasty with balloon dilatation is a simple and effective minimally invasive treatment for pediatric PUJ obstruction, particularly for lower pelvic obstructions.
- The procedure is associated with short hospital stays and positive long-term outcomes regarding drainage and function.
Abstract:
Congenital and acquired pelviureteric junction obstruction (PUJ) were treated with balloon dilatation, using a Fogarty/Gruntzig catheter introduced through the cystoscope in 11 children (12 renal units). Stents were not used, and the hospitalization period was only 1 day for uncomplicated cases. Follow-up (maximum period, 4 1/2 years) has shown better drainage and function for all. In one child, who had solitary left kidney, acute obstruction developed; the patient underwent temporary percutaneous nephrostomy. Macroscopic hematuria was noted in one case, resulting in a 3-day hospital stay. Technical problems, advantages, and disadvantages are discussed. Retrograde ureteroplasty using balloon dilatation is a simple and effective procedure for children in whom the obstructed PUJ is in lower part of the pelvis.