High-pressure balloon dilatation in children: our results in 30 patients with POM and the implications of the cystoscopic evaluation

  • Francesca Destro | francesca_destro@hotmail.com Paediatric Surgery and Paediatric Urology Department, Buzzi Children’s Hospital, Milan, Italy.
  • Giorgio Selvaggio Paediatric Surgery and Paediatric Urology Department, Buzzi Children’s Hospital, Milan, Italy.
  • Federica Marinoni Paediatric Surgery and Paediatric Urology Department, Buzzi Children’s Hospital, Milan, Italy.
  • Andrea Pansini Paediatric Surgery and Paediatric Urology Department, Buzzi Children’s Hospital, Milan, Italy.
  • Giovanna Riccipetitoni Paediatric Surgery and Paediatric Urology Department, Buzzi Children’s Hospital, Milan, Italy.

Abstract

Primary Obstructive Megaureter (POM) is a common cause of hydronephrosis in children with spontaneous resolution in most cases. High-Pressure Balloon Dilatation (HPBD) has been proposed as a minimally invasive procedure for POM correction in selected patients. The aim of the paper is to review our experience with HPBD in patients with POM. We performed a retrospective study in a single Centre collecting data on patients’ demographics, diagnostic modalities, surgical details, results and follow-up. In particular, the endoscopic aspect of the orifice permitted the identification of 3 patterns: adynamic ureteral segment, stenotic ureteric ring and pseudoureterocelic orifice. We performed HPBD in 30 patients over 6 years. We had 23 patients with adynamic distal ureteral segment (type 1), 4 with stenotic ring (type 2) and 3 with ureterocelic orifice (type 3). In 3 patients (10%) the guidewire did not easily pass into the ureter requiring ureteral stenting or papillotomy. Post-operative course was uneventful. Five patients (3 pseudoureterocelic) required open surgery during follow-up. HPBD for the treatment of POM is a safe and feasible procedure and it can be a definitive treatment of POM. Complications are mainly due to double J stent and none of our patients had symptoms related to vescico-ureteral reflux. The aspect of the orifice, identified during cystoscopy, seems to correlate with the efficacy of the dilatation: type 1 and 2 are associated with good and excellent results respectively; type 3 do not permit dilatation in almost all cases requiring papillotomy. HPBD can be performed in selected patients of all paediatric ages as first therapeutic line. The presence of a pseudoureterocelic orifice or long stenosis might interfere with the ureteral stenting and seems associated with worse outcomes.

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Published
2020-10-08
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Keywords:
primary obstructive megaureter, high-pressure balloon dilatation, hydro-ureteronephrosis
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How to Cite
Destro, F., Selvaggio, G., Marinoni, F., Pansini, A., & Riccipetitoni, G. (2020). High-pressure balloon dilatation in children: our results in 30 patients with POM and the implications of the cystoscopic evaluation. La Pediatria Medica E Chirurgica, 42(1). https://doi.org/10.4081/pmc.2020.214