Long-Term Outcomes in Primary Obstructive Megaureter Treated by Endoscopic Balloon Dilation. Experience After 100 Cases
| Autor: | Burgos L, Ruben Ortiz, Jose Maria Angulo, Laura Pérez-Egido, Alberto Parente |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Megaureter medicine.medical_treatment hydroureteronephrosis 030232 urology & nephrology Renal function Balloon Pediatrics ureteral obstruction 03 medical and health sciences 0302 clinical medicine medicine Hydronephrosis Original Research business.industry lcsh:RJ1-570 Balloon catheter Stent lcsh:Pediatrics medicine.disease primary obstructive megaureter Surgery 030220 oncology & carcinogenesis Pediatrics Perinatology and Child Health Balloon dilation long term business Complication endoscopic balloon dilation |
| Zdroj: | Frontiers in Pediatrics Frontiers in Pediatrics, Vol 6 (2018) Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid Consejería de Sanidad de la Comunidad de Madrid |
| ISSN: | 2296-2360 |
| Popis: | Aim: To assess long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation (EBD) in the largest series reported.Patients and Methods: Hundred POM in 92 consecutive patients were treated by EBD between years 2004 and 2016. A total of 79 POM (73 patients) with more than 18 months of follow-up after treatment have been analyzed. EBD of the vesicoureteral junction was performed with semicompliant high-pressure balloon catheters (2.7FG) with minimum balloon diameter of 5 mm, followed by temporary Double-J stent placement. Follow-up protocol included periodical clinical reviews, US and MAG-3 renogram scans.Results: Median age at surgery was 4 months (15 days−3.6 years), with median operating time of 20 min (10–60) and hospital stay of 1 day (1–7). Initial renal function was preserved in all patients with significant improvement in renal drainage on the MAG-3 diuretic renogram after endoscopic treatment (p < 0.001 T-test). Significant post-operative differences were observed in hydronephrosis grade and ureteral diameter that were maintained in the long-term (p < 0.001 T-test). Endoscopic approach of POM had a long-term success rate of 87.3%, with a mean follow-up of 6.4 ± 3.8 years. Secondary VUR was found in 17 cases (21.5%), being successfully treated by endoscopic subureteral injection in 13 (76.4%). Nine cases developed long-term re-stenosis (12.2%) that were successfully treated with a new EBD in 8. Endoscopic management of POM failed in 10 cases (12.7%) that required ureteral reimplantation. Five were early failures (4 intraoperative technical problems and 1 double-J stent migration with severe re-stenosis), and 5 long-term (4 persistent VUR and 1 re-stenosis recurrence).Conclusion: EBD has shown to be an effective treatment of POM with few complications and good outcomes at long-term follow up. Main complication was secondary VUR that could also be treated endoscopically with a high success rate. In our opinion, EBD may be considered first-line treatment in POM. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|