MP70-09 HIGH PRESSURE BALLOON DILATION FOR OBSTRUCTIVE MEGAURETER PATHOLOGIES IN THE PEDIATRIC PATIENT: STENT MIGRATIONS AND OTHER LESSONS LEARNED

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP70-09 HIGH PRESSURE BALLOON DILATION FOR OBSTRUCTIVE MEGAURETER PATHOLOGIES IN THE PEDIATRIC PATIENT: STENT MIGRATIONS AND OTHER LESSONS LEARNED Timothy Boswell, Carol Davis-Dao, Kai-Wen Chuang, Heidi Stephany, Elias Wehbi, and Antoine Khoury Timothy BoswellTimothy Boswell More articles by this author , Carol Davis-DaoCarol Davis-Dao More articles by this author , Kai-Wen ChuangKai-Wen Chuang More articles by this author , Heidi StephanyHeidi Stephany More articles by this author , Elias WehbiElias Wehbi More articles by this author , and Antoine KhouryAntoine Khoury More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: High pressure balloon dilation (HPBD) is a treatment option for obstructive pathologies at the ureterovesical junction (UVJ). While it is less invasive than open reimplant, little has been described regarding technical factors or stent migrations which may pose challenges to its successful completion. METHODS: All patients from a single institution who underwent HPBD between 2009 and May 2022 were retrospectively reviewed. Those with obstructive pathologies at the UVJ included primary obstructive megaureter, obstructed refluxing megaureter, and obstructive megaureter secondary to neurogenic bladder or posterior urethral valves. Patients with prior treatment at the UVJ including reimplantation or endoscopic injection were excluded. Following HPBD, each patient had two indwelling ureteral stents placed. Success rates, technical factors, and stent migrations were analyzed. RESULTS: A total of 42 patients and 43 ureters were treated for obstructive pathologies at the UVJ. Median age was 14 months (IQR 7 – 89). Thirty four patients (81%) had primary obstructive megaureter (one bilateral), 4 (9%) had obstructed refluxing megaureter, and 4 (9%) had obstructive megaureter with underlying neurogenic bladder or posterior urethral valves. With a median follow-up of 2.4 years (IQR 1.7 – 3.8), 34 (79%) ureters were successfully managed endoscopically and did not require subsequent open surgery. Eight (19%) required reimplant and 1 (2%) diverting ureterostomy. Operative notes did not describe procedural difficulty in 19 (44%) cases; the remainder referenced narrow stenosis making cannulation difficult, and/or difficulty passing wires and stents up tortuous ureters. Four (10%) patients had intraoperative proximal stent migration, which was recognized permitting immediate repositioning of the stents. Five (12%) patients experienced postoperative stent migrations (3 of both stents, 2 of one stent). Ten (24%) patients required an additional anesthetic to complete HPBD after passive dilation by a stent (n=7) or repeat dilation due to double stent migration (n=3). All 3 patients who experienced postoperative migration of both stents required open surgery due to progressive hydroureteronephrosis. CONCLUSIONS: Approximately 80% of obstructive pathologies at the UVJ can be managed endoscopically with HPBD. Surgeons should be prepared to address the tight stenosis and tortuous megaureter that can pose a challenge to the endoscopic approach and may predispose to ureteral stent migration. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1007 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Timothy Boswell More articles by this author Carol Davis-Dao More articles by this author Kai-Wen Chuang More articles by this author Heidi Stephany More articles by this author Elias Wehbi More articles by this author Antoine Khoury More articles by this author Expand All Advertisement PDF downloadLoading ...