Endoscopic balloon dilatation of primary obstructive megaureter: An effective first line management in children.

Autor: Awolaran O; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom., Nwachukwu I; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom., Paul A; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom., Garriboli M; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom., Taghizadeh A; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom., Lobo S; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom., Awad K; Paediatric Urology Department, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom; Department of Pediatric Surgery, Children's Hospital, Ain Shams University Hospitals, Cairo, Egypt., Burns K; Paediatric Urology Department, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom., Shalaby M; Paediatric Urology Department, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom., Woodward M; Paediatric Urology Department, Bristol Royal Hospital for Children, Paul O'Gorman Building, Upper Maudlin Street, Bristol BS2 8BJ, United Kingdom., Mishra P; Paediatric Urology Department, Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom. Electronic address: pankaj.mishra@gstt.nhs.uk.
Jazyk: angličtina
Zdroj: Journal of pediatric urology [J Pediatr Urol] 2024 Sep 12. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1016/j.jpurol.2024.09.007
Abstrakt: Aim: This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children.
Methods: Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period.
Results: 55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25 mm (p = 0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation.
Discussion: Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25 mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature.
Conclusions: This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.
Competing Interests: Conflict of interest The authors declare no conflict of interest.
(Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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