Abstract
Aim of the Study: We described the initial experience of four referral centers in the treatment of primary obstructive megaureter (POM) in children, by high-pressure balloon dilatation (HPBD) of the ureterovesical junction with double JJ stenting. We managed a retrospective multicenter study to assess its effectiveness in long-term.Methods: We reviewed the medical records of all children who underwent HPBD for POM that require surgical treatment from May 2012 to December 2017 in four different institutions. The primary outcome measured was ureterohydronephrosis (UHN) and its degree of improvement after the procedure. Secondary outcomes were postoperative complications and resolution of preoperative symptomatology.Main Results: Forty-two ureters underwent HPBD for POM in 33 children, with a median age of 14.7 months – (range: 3 months −15 years). Ureterohydronephrosis improves in 86% of ureters after one endoscopic treatment. Three cases required a second HPBD. Four patients required surgical treatment for worsening of UHN after endoscopic treatment. The post-operative complication rate was 50% (21 ureters). In 13 cases (61%), they were related to double J stent. The median follow-up was 24 months (2 months −5 years) and all patients were symptom-free.Conclusion: We reported the first multicenter study and the largest series of children treated with HPBD, with an overall success rate of 92%. Endoscopic treatment can be a definitive treatment of POM since it avoided reimplantation in 90% of cases. Complications are mainly due to double J stent.
Highlights
In the majority of cases, primary obstructive megaureter (POM) improves or disappears spontaneously without compromising renal function (1, 2)
The objective of this study is to describe the initial experience of 4 referral centers in the treatment of POM by high-pressure balloon dilatation (HPBD) of the ureterovesical junction with double JJ stenting and to assess its effectiveness in the long-term
We reviewed the medical records of all children who underwent HPBD for POM that require surgical treatment from May 2012 to December 2017 in four different institutions (Tours, Rouen, Angers and Besançon)
Summary
In the majority of cases, primary obstructive megaureter (POM) improves or disappears spontaneously without compromising renal function (1, 2). Thereby, conservative management is currently used for initial approach for POM. These past two decades, surgical management of POM was revised. For decades reimplantation with ureteral tapering has been an established treatment for progressive or persistent POM. Primary Obstructive Megaureter: Endoscopic Treatment associated with significant obstruction and/or infection (3). The disproportion between the size of the dilated ureter and the size of the bladder especially in children of
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