Long-Term Follow-Up of Balloon Dilation for Primary Obstructive Megaureter

Abstract

Introduction: Management of the primary obstructive megaureter (POM) has greatly changed over the past years. In most cases, the conservative management is the first option. Surgical treatment is undertaken when the conservative management fails. The standard treatment is open surgery with ureter reimplantation. The objective of this video is to show the endoscopic dilatation of the POM as an alternative to the standard surgical treatment. Materials and Methods: We use a 10.5F Storz compact cystoscope with a 5F work channel under general anesthesia. A flexible guide is introduced in the ureter, and it is progressed up to the renal pelvis. A 3F–5F balloon catheter is passed over the guide and left positioned above and beneath the area to be dilated (the balloon's position is fluoroscopically controlled). The stenotic segment is dilated by inflating the balloon with a contrast medium up to a pressure of 12–14 atm, and the rupture of the problem area is verified by means of X-rays. A Double-J is left. The catheter is removed after 2 months. Results: A total of 19 patients and 20 ureters were treated with the endoscopic balloon dilation technique. Sixteen patients were males and three were females. Ten cases were left sided, eight right sided, and one bilateral. The median age at surgery was 17 months (range, 1–44 months), with prenatal diagnosis in 11 cases. No intraoperative events occurred. Eighteen ureters showed a nonobstructive pattern on MAG-3 renogram after the first endoscopic dilatation, representing a 90% success rate. One case required a second dilatation, which proved successful. The overall success rate of the technique was thus 95%. Renal function was preserved in 18 patients (95%). Complications comprised one urinary tract infection, one case of reflux, and two cases of recurrent lithiasis requiring ureterotomy. The mean follow-up is 6.9 years (range, 3.9–13.3 years). One patient was lost to follow-up. Conclusions: According to our experience, the endoscopic management has yielded good results in the medium term. The obstructive process disappeared without any added morbidity. However, multicenter studies and prospective trials should be encouraged to provide more definitive evidence on its benefits. The authors declare that no competing financial interests exist. Runtime of video: 5 mins