Antegrade balloon dilatation of pelvi-ureteric junction obstruction in children

Abstract

Purpose To report our experience and early results in the use of antegrade endoluminal balloon dilatation as a primary treatment of PUJO in children. Material and Methods Prospective study of children undergoing antegrade endoluminal balloon dilatation of primary PUJO at our center since July 2006. Information was collected on patient demographics, clinical presentation, the procedure of balloon dilatation, renal function and ultrasound measurement of renal pelvic antero-posterior diameter pre- and post-operatively. The procedure was performed under fluoroscopic control using the antegrade placement route for catheter (4Fr or 5Fr) and guidewire. A high pressure balloon (2 mm, 3 mm or 4 mm) was then passed over the wire and positioned across the stenosis for dilatation. A double J stent was then inserted for six weeks. Results We performed 14 balloon dilatations on 14 patients. Nine patients were in the infant age group (under 1 year). The mean age was 14.2 months (range 2 months to 7 years); 66% were male and 33% female. Mean follow up was 17 months (range 4 – 26) and 9 of the 14 patients have a minimum follow up period of 16 months. Mean renal pelvic AP diameter reduced from 3.64 cm (range 3.2 – 4.9) to 1.76 cm (range 1.1 – 2.4). Ipsilateral renal excretion (on MAG3 isotope scanning) improved postoperatively in all patients who underwent MAG3 scans postoperatively (9 out of 15 patients). There was one complication of minor contrast extravasation that happened during balloon dilatation. It proved not to be clinically detrimental in the immediate post-op period or on follow-up. Conclusions Antegrade balloon dilatation is a feasible and safe option in the treatment of primary PUJ obstruction in children. The minimally invasive nature of this technique and our encouraging early results leads us to conclude that this method warrants further clinical evaluation as an alternative to open pyeloplasty.