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Retrograde balloon dilatation for primary pelvi-ureteric junction stenosis in children
Y Sugita1, T D Clarnette, J M Hutson
1F. Douglas Stephens Surgical Research Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Retrograde balloon dilatation (RBDP) for primary pelvi-ureteric junction (PUJ) stenosis in children showed a significant failure rate. Recurrent stenosis and anatomical challenges limited RBDP
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Renal Physiology
Background:
- Primary pelvi-ureteric junction (PUJ) stenosis is a common cause of pediatric hydronephrosis.
- Traditional surgical repair, such as pyeloplasty, has been the gold standard.
- Minimally invasive techniques are being explored to improve outcomes and reduce morbidity.
Purpose of the Study:
- To evaluate the efficacy of retrograde balloon dilatation (RBDP) as a primary treatment for pediatric PUJ stenosis.
- To assess the success and failure rates of RBDP in relieving PUJ obstruction.
- To identify factors contributing to the failure of RBDP.
Main Methods:
- Retrospective analysis of 16 children with primary PUJ stenosis treated with RBDP.
- Diuretic renography used for diagnosis and post-operative assessment.
- Follow-up duration ranged from 9 to 38 months (mean 25 months).
Main Results:
- RBDP was successful in 8 out of 17 renal units (47%).
- Failure occurred in 9 out of 17 renal units (53%) due to inability to pass the catheter or recurrent/persistent stenosis.
- Minimal morbidity was associated with the procedure.
Conclusions:
- RBDP has a significant failure rate in treating primary PUJ stenosis in children.
- Factors influencing failure include anatomical challenges and recurrent stenosis, potentially due to scarring from over-dilatation.
- Reduction pyeloplasty may be a more suitable option for complex cases.
Objective:
To evaluate the efficacy of retrograde balloon dilatation for primary pelvi-ureteric junction (PUJ) stenosis (RBDP) in children.
Patients And Methods:
Sixteen children (12 boys, four girls; mean age 29 months) with primary PUJ stenosis initially underwent RBDP. A double-pigtail catheter was left in the ureter for 6 weeks to provide drainage. The initial diagnosis of PUJ stenosis and the subsequent post-operative assessment were both made by diuretic renography in almost all patients. All children were followed up for between 9 and 38 months (mean 25) after the procedure.
Results:
RBDP was unsuccessful in nine of 17 renal units. In three of these, failure was caused by inability to pass the catheter through the PUJ or vesico-ureteric junction (VUJ). In six cases, failure was caused by recurrent or persistent stenosis. In eight of 17 renal units, RBDP was successful in relieving the stenosis. The morbidity from the procedure was minimal.
Conclusions:
Long-term follow-up revealed a significant failure rate for RBDP, caused by the inability to pass the catheter through the VUJ or PUJ, or persistent and/or recurrent stenosis. Recurrent stenosis may result from excessive dilatation which traumatizes the PUJ and causes subsequent scarring. Failure to overcome the stenosis is thought to be caused by a large redundant renal pelvis, producing 'kinking' of the upper ureter. In these cases, only reduction pyeloplasty may be successful in relieving the obstruction.