"Bambino Gesù" Children's Hospital and Research Institute, Dept. Neprology-Urology, Surgical Unit of the Pediatric Renal Transplant and Correlated Patologies, Rome, Italy.
Although conservative management is indicated in most cases of primary obstructed megaureter (POM), surgery is still indicated when POM is associated with increasing dilation, symptoms or progressive renal damage. However, surgery is associated with a significant rate of complications, especially in the case of very large ureter in the first year of life. A valid alternative could be endoscopic high pressure balloon dilation (EHPBD) of the vesicoureteral junction (VUJ). We report the first experience with EHPBD in patients under 1 year of age affected by severe POM.
Five patients aged between 6 and 12 months, were treated with EHPBD. In all patients, preoperative renal ultrasound showed a distal ureteral dilation ≥ 15mm, which increased at later evaluations; an obstructive pattern was detected at the preoperative diuretic renography. An 8-9,8F cystoscope and a 3F balloon catheter (balloon maximum diameter 4 mm) was used. The VUJ was dilated for 5 minutes at 12-14 atm. A 4.7F double J stent was then positioned and left in place for 6-8 weeks. Ultrasound was performed every 3 months, and renography and voiding cystourethrography the fourth month after the EHPBD.
No operative complications were observed. All the patients showed an improvement at the ultrasound postoperative check upfollow-up and there was no evidence of obstruction/reflux at the postoperative renographycheck up.
Our preliminary results seem to indicate that EHPBD is a feasible, safe and successful procedure. It could play a role as a minimally invasive alternative to open surgery in selected cases of POM, requiring intervention in the first year of life. Longer follow-up is necessary to verify the stability of these results.
Written by:
Torino G, Collura G, Mele E, Garganese MC, Capozza N. Are you the author?
Reference: J Endourol. 2011 Nov 3. Epub ahead of print.
doi: 10.1089/end.2011.0399
PubMed Abstract
PMID: 22050492
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