Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center
| Autor: | Fátima Alves, Sofia Morão, Vanda Pratas Vital, João Pascoal, Filipe Catela Mota, Dinorah Cardoso |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Megaureter 030232 urology & nephrology Constriction Pathologic Hydronephrosis HDE URO PED Ureter/abnormalities Biochemistry Asymptomatic Vesicoureteral reflux 03 medical and health sciences 0302 clinical medicine Ureter medicine Child medicine.diagnostic_test business.industry Organic Chemistry Endoscopy medicine.disease Dilatation Surgery Catheter medicine.anatomical_structure 030220 oncology & carcinogenesis Balloon dilation medicine.symptom business Ureteral Obstruction |
| Zdroj: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação instacron:RCAAP |
| Popis: | Introduction: Congenital obstructive megaureter may be treated with endoscopic balloon dilatation, particularly in children under one year of age. We report our experience over a six year period. Methods: All patients with diagnosis of primary obstructive megaureter treated with endoscopic balloon dilatation from 2009 to 2014 (6 years) were included. The diagnosis of primary obstructive megaureter was based on dilatation of the distal ureter greater than 7 mm, obstructive curve on MAG-3 diuretic renogram and absence of vesicoureteral reflux. After diagnosis, conservative management was maintained with antibiotic prophylaxis in all patients. The indications for surgery were a combination of clinical, ultrasonographic and renographic findings. Under general anesthesia and after retrograde ureteropielography, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A double-J catheter was positioned. Follow-up was performed with ultrasonography and diuretic renogram. The success of the intervention was defined by improvement of hydroureteronephrosis (at least 2 grades). Results: A total of nine patients underwent this procedure on a single ureter, two girls and seven boys, with a mean age of 7.6 months (range 1-14) at the intervention. Five were left sided and four were right sided. All patients had prenatal diagnosis of hydroureteronephrosis. No patients were lost to follow-up (average 46.7 months). They all had hydroureteronephrosis greater than grade 3 and preoperative MAG-3 diuretic renogram was obstructive in all cases. Mean differential function of the affected kidney was 46.2% (range 40-53%). The main indication for surgical treatment was progressive hydroureteronephrosis. All patients were treated endoscopically with no intraoperative complications. Ultrasound showed improvement of the hydroureteronephrosis in six patients (66.7%). Three patients were reimplanted (33.3%). The mean differential renal function after the procedure was 47.4% (range 41-53%). At the latest follow-up assessment, all patients remained asymptomatic. Conclusion: Endoscopic balloon dilatation is a useful option in the management of primary obstructive megaureter requiring surgical intervention and may be considered first line treatment in small children. info:eu-repo/semantics/publishedVersion |
| Databáze: | OpenAIRE |
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