https://doi.org/10.4081/pmc.2020.214

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

Vol. 42 No. 1 (2020)
Submitted: 20 July 2019
Accepted: 18 February 2020
Published: 8 October 2020
primary obstructive megaureter, high-pressure balloon dilatation, hydro-ureteronephrosis
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Authors

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.

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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Crossref
Scopus
Google Scholar
Europe PMC
Doudt AD, Pusateri CR, Christman MS. Endoscopic Management of Primary Obstructive Megaureter: A Systematic Review. J Endourol. 2018 Jun;32(6):482-487. DOI: https://doi.org/10.1089/end.2017.0434
Angerri O, Caffaratti J, Garat JM, Villavicencio H. Primary obstructive megaureter: initial experience with endoscopic dilatation. J Endourol. 2007 Sep;21(9):999-1004. DOI: https://doi.org/10.1089/end.2006.0122
Casal Beloy I, Somoza Argibay I, García González M, García Novoa MA, Míguez Fortes LM, Dargallo Carbonell T. Endoscopic balloon dilatation in primary obstructive megaureter: Long-term results. J Pediatr Urol. 2018. Apr;14(2):167.e1-167.e5. DOI: https://doi.org/10.1016/j.jpurol.2017.10.016
Bujons A, Saldaña L, Caffaratti J, Garat JM, Angerri O, Villavicencio H. Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up? J Pediatr Urol. 2015 Feb;11(1):37.e1-6. DOI: https://doi.org/10.1016/j.jpurol.2014.09.005
García-Aparicio L, Blázquez-Gómez E, de Haro I, Garcia-Smith N, Bejarano M, Martin O, Rodo J. Postoperative vesicoureteral reflux after high-pressure balloon dilation of the ureterovesical junction in primary obstructive megaureter. Incidence, management and predisposing factors. World J Urol. 2015 Dec;33(12):2103-6. doi: 10.1007/s00345-015-1565-9. DOI: https://doi.org/10.1007/s00345-015-1565-9
Kassite I, Braïk K, Morel B, Villemagne T, Szwarc C, Maakaroun Z, Cook AR, Lardy H, Binet A. High pressure balloon dilatation of the ureterovesical junction in primary obstructive megaureter: Infectious morbidity. Prog Urol. 2017 Sep;27(10):507-512. DOI: https://doi.org/10.1016/j.purol.2017.07.005
Tekgül S, Dogan HS, Hoebeke P, Kocvara R, Nijman JM, Radmayr C, Stein R, Erdem E, Nambiar AK, Silay MS, Undre S. EAU Guidelines on Pediatric Urology. European Society of Pediatric Urology. March 2016
Romero RM, Angulo JM, Parente A, Rivas S, Tardáguila AR. Primary obstructive megaureter: the role of high pressure balloon dilation. J Endourol. 2014 May;28(5):517-23. DOI: https://doi.org/10.1089/end.2013.0210
Carroll D, Chandran H, Joshi A, McCarthy LS, Parashar K.Endoscopic placement of double-J ureteric stents in childrenas a treatment for primary obstructive megaureter. Urol Ann2010;2:114e8. DOI: https://doi.org/10.4103/0974-7796.68860
Capozza N, Torino G, Nappo S, Collura G, Mele E. Primary obstructive megaureter in infants: our experience with endoscopic balloon dilation and cutting balloon ureterotomy. J Endourol. 2015 Jan;29(1):1-5. DOI: https://doi.org/10.1089/end.2013.0665
García-Aparicio L, Blázquez-Gómez E, Martin O, Palazón P, Manzanares A,García-Smith N, Bejarano M, de Haro I, Ribó JM. Use of high-pressure balloon dilatation of the ureterovesical junction instead of ureteral reimplantation to treat primary obstructive megaureter: is it justified? J Pediatr Urol. 2013 Dec;9(6 Pt B):1229-33. DOI: https://doi.org/10.1016/j.jpurol.2013.05.019
Torino G, Collura G, Mele E, Garganese MC, Capozza N. Severe primary obstructive megaureter in the first year of life: preliminary experience with endoscopic balloon dilation. J Endourol. 2012 Apr;26(4):325-9. DOI: https://doi.org/10.1089/end.2011.0399
Christman MS, Kasturi S, Lambert SM, Kovell RC, Casale P. Endoscopic management and the role of double stenting for primary obstructive megaureters. J Urol. 2012 Mar;187(3):1018-22. doi: 10.1016/j.juro.2011.10.168. DOI: https://doi.org/10.1016/j.juro.2011.10.168
Ortiz R, Parente A, Perez-Egido L, Burgos L, Angulo JM. Long-Term Outcomes in Primary Obstructive Megaureter Treated by Endoscopic Balloon Dilation. Experience After 100 Cases. Front Pediatr. 2018 Oct 5;6:275. DOI: https://doi.org/10.3389/fped.2018.00275
García-Aparicio L, Blázquez-Gómez E, Martin O, Krauel L, de Haro I, Rodó J. Bacterial characteristics and clinical significance of ureteral double-J stents in children. Actas Urol Esp. 2015 Jan-Feb;39(1):53-6. DOI: https://doi.org/10.1016/j.acuroe.2014.11.002
García-Aparicio L, Rodo J, Palazon P, Martín O, Blázquez-Gómez E, Manzanares A, García-Smith N, Bejarano M, de Haro I, Ribó JM. Acute and delayed vesicoureteral obstruction after endoscopic treatment of primary vesicoureteral reflux with dextranomer/hyaluronic acid copolymer: why and how to manage. J Pediatr Urol. 2013 Aug;9(4):493-7 DOI: https://doi.org/10.1016/j.jpurol.2013.02.007
Bapat S, Bapat M, Kirpekar D. Endoureterotomy for congenital primary obstructive megaureter: preliminary report. J Endourol. 2000 Apr;14(3):263-7 DOI: https://doi.org/10.1089/end.2000.14.263

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

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