OPTIMIZATION OF SURGICAL TREATMENT OF PRIMARY OBSTRUCTIVE MEGAURETER IN YOUNG CHILDREN

Abstract

Introduction. The primary obstructive megaureter in children of the first months and years of life does not require surgical treatment in most cases. But if the kidney function deteriorates and an obstructive pattern of urodynamics of the upper urinary tract is formed, then surgical intervention is required. Reimplantation is usually applied, if a patient is older than one year. In infants, minimally invasive endoscopic methods are more applicable. Nevertheless, results of treatment are ambiguous and not satisfactory in some cases. Purpose. To assess and to compare levels of efficiency of endoscopic stenting, high pressure balloon dilatation (HPBD) and reimplantation. To propose an algorithm for the selection and sequential application of the discussed surgical procedures depending on patient’s age and on the degree of renal function damage. Material and methods. 224 children were taken into the study. They were divided into three groups. Stenting, HPBD or reimplantation were used as a treatment modality in each group, respectively. Effectiveness criteria were: improvement of renal function by the nephroscintigraphy, reduction in size of the ureter and excretory system as well as the increase in parenchyma volume by ultrasound. Non-parametric statistics - Wilcoxon test, chi-square test, Spearman correlation. The level of significance is 0.05. Results. Stenting is effective in 48% of children of the first year of life, but in older patients its effectiveness significantly decreases (about 20%). A high level of HPBD efficiency (about 70%) was achieved in subgroups of patients of the first three years of life; however, it was significantly lower in patients of older age. Reimplantation is maximally effective (about 98%) in subgroups of patients older than one, but not effective (33%) in the subgroup of patients of the first year of life. Conclusion. Endoscopic stenting is indicated for patients of the first year of life with minimal disorders in their urodynamics and renal function, while it is not an option for older patients. HPBD is more effective in patients of the first two years of life with moderate urodynamic disorders. Reimplantation with the effectiveness level about 100% is a method of choice in patients older than one year and cannot be recommended in infancy.