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
Submitted: 20 July 2019
Accepted: 18 February 2020
Published: 8 October 2020
Accepted: 18 February 2020
Abstract Views: 995
PDF: 619
HTML: 29
HTML: 29
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
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.
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, GarcÃa González M, GarcÃa Novoa MA, MÃguez 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
GarcÃa-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
GarcÃa-Aparicio L, Blázquez-Gómez E, Martin O, Palazón P, Manzanares A,GarcÃa-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
GarcÃa-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
GarcÃa-Aparicio L, Rodo J, Palazon P, MartÃn O, Blázquez-Gómez E, Manzanares A, GarcÃa-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
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Michele Corroppolo, Elisa Pani, Maria Teresa Bortolami, Hamid Reza Sadri, Fabio Beretta, Clara Revetria, Giosuè Mazzero, Enrico Ciardini, Caecal duplication, a case report , La Pediatria Medica e Chirurgica: Vol. 43 No. 2 (2021)
- Kibwe Alphonse Simbi, Valentin Kazadi, Louis-Marie Aissi, François Mbahewaka Katsuva, Numbi Oscar Luboya, Léon Tshilolo, Vincenzo Zanardo, Pediatric pleural empyema: one of the management challenges in children of Democratic Republic of Congo , La Pediatria Medica e Chirurgica: Vol. 39 No. 2 (2017)
- Massimo Agosti, Francesco Tandoi, Laura Morlacchi, Angela Bossi, Nutritional and metabolic programming during the first thousand days of life , La Pediatria Medica e Chirurgica: Vol. 39 No. 2 (2017)
- Valentina Bozzetti, Paolo E. Tagliabue, Enteral nutrition for preterm infants: by bolus or continuous? An update , La Pediatria Medica e Chirurgica: Vol. 39 No. 2 (2017)
- Valentina Bozzetti, Paolo E. Tagliabue, Enteral feeding of intrauterine growth restriction preterm infants: theoretical risks and practical implications , La Pediatria Medica e Chirurgica: Vol. 39 No. 2 (2017)
- Salvatore Fabio Chiarenza, Maria Luisa Conighi, Andrea Conforti, Ciro Esposito, Maria Escolino, Fabio Beretta, Maurizio Cheli, Vincenzo Di Benedetto, Maria Grazia Scuderi, Giovanni Casadio, Maurizio Marzaro, Leon Francesco Fascetti, Claudio Vella, Cosimo Bleve, Daniela Codric, Paolo Caione, Pietro Bagolan, Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of the esophageal atresia , La Pediatria Medica e Chirurgica: Vol. 39 No. 3 (2017)
- Salvatore Fabio Chiarenza, Cosimo Bleve, Ciro Esposito, Maria Escolino, Fabio Beretta, Maurizio Cheli, Vincenzo Di Benedetto, Maria Grazia Scuderi, Giovanni Casadio, Maurizio Marzaro, Leon Francesco Fascetti, Pietro Bagolan, Claudio Vella, Maria Luisa Conighi, Daniela Codric, Simona Nappo, Paolo Caione, Guidelines of the Italian Society of Videosurgery in Infancy for the minimally invasive treatment of the ureteropelvic-junction obstruction , La Pediatria Medica e Chirurgica: Vol. 39 No. 3 (2017)
- Valentina Luppi, Michele Mazzi, Andrea Micaglio, Arturo Rebeccato, Neglected patellar tendon rupture in tibial tubercle avulsion fracture in an adolescent: A case report , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Giacomo Riva, Luca Monestier, Mirko Colombo, Fabio D'angelo, Michele Francesco Surace, Subtalar arthroeresis with peek endorthesis in juvanile flexible flafoot: Short-term results , La Pediatria Medica e Chirurgica: Vol. 44 No. s1 (2022)
- Mario Lima, Dora Persichetti-Proietti, Neil Di Salvo, Claudio Antonellini, Michele Libri, Beatrice Randi, Michela Maffi, Tommaso Gargano, Giovanni Ruggeri, Vincenzo Davide Catania, The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis , La Pediatria Medica e Chirurgica: Vol. 41 No. 1 (2019)
You may also start an advanced similarity search for this article.