Endoscopic balloon dilation of primary obstructive megaureter: is fluoroscopic guidance necessary?
Endoscopic balloon dilation
Endourological treatment
High-pressure balloon dilation
Outcome
Primary obstructive megaureter
Uretero-hydronephrosis
Journal
World journal of urology
ISSN: 1433-8726
Titre abrégé: World J Urol
Pays: Germany
ID NLM: 8307716
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
received:
26
03
2023
accepted:
08
08
2023
medline:
23
10
2023
pubmed:
10
9
2023
entrez:
10
9
2023
Statut:
ppublish
Résumé
To compare the long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation under fluoroscopic guidance versus not using radioscopy during the procedure. A comparative study between POM cases treated at our institution by endoscopic balloon dilation (EBD) under fluoroscopic guidance (FG) (n = 43) vs no fluoroscopic guidance (NFG) (n = 48) between the years 2004 and 2018 was conducted. The procedure in FG consisted of performing a retrograde pyelography before dilation. Then, a guidewire is introduced to the renal pelvis, and the dilation of the vesicoureteral junction is performed using high-pressure balloon catheters under fluoroscopic vision. Finally, a double-J stent is placed between the renal pelvis and bladder. The procedure in NFG was performed exclusively under cystoscopic vision without radiological exposure. Complications, outcomes, and success rates were analyzed using Spearman's correlation test. Mean follow-up was 12.5 ± 2.2 years in FG and 6.4 ± 1.3 years in NFG. MAG-3 showed significant differences in renal drainage before and after endoscopic treatment in both groups (p < 0.001 T-test). Statistical analysis did not reveal differences between groups in initial technical failure (r: - 0.035, p = 0.74), early postoperative complications (r: - 0.029, p = 0.79), secondary VUR (r: 0.033, p = 0.76), re-stenosis (r: 0.022, p = 0.84), long-term ureteral reimplantation (r: 0.065, p = 0.55), and final outcome (r: - 0.054, p = 0.61). The endoscopic approach of POM had a long-term success rate of 86.5% in FG VS 89.6% in NFG. Endoscopic balloon dilation of POM can be done with no radiation exposure with similar results, effectiveness, and outcomes.
Identifiants
pubmed: 37690062
doi: 10.1007/s00345-023-04572-z
pii: 10.1007/s00345-023-04572-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2861-2867Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Di Renzo D, Aguiar L, Cascini V, Di Nicola M, McCarten KM, Ellsworth PI et al (2013) Long-term follow-up of primary nonrefluxing megaureter. J Urol 190(3):1021–1026
doi: 10.1016/j.juro.2013.03.008
pubmed: 23500640
Dekirmendjian A, Braga LH (2019) Primary non-refluxing megaureter: analysis of risk factors for spontaneous resolution and surgical intervention. Front Pediatr 7:126
doi: 10.3389/fped.2019.00126
pubmed: 31111023
pmcid: 6499225
Hendren WH (1975) Complications of megaureter repair in children. J Urol 113(2):238–254
doi: 10.1016/S0022-5347(17)59454-9
pubmed: 1113422
Perdzynski W, Kalicinski ZH (1996) Long-term results after megaureter folding in children. J Pediatr Surg 31(9):1211–1217
doi: 10.1016/S0022-3468(96)90234-1
pubmed: 8887086
Romero RM, Angulo JM, Parente A, Rivas S, Tardaguila AR (2014) Primary obstructive megaureter: the role of high pressure balloon dilation. J Endourol Endourol Soc 28(5):517–523
doi: 10.1089/end.2013.0210
Bujons A, Saldana L, Caffaratti J, Garat JM, Angerri O, Villavicencio H (2015) Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up? J Pediatr Urol. 11(1):37 (e1–6)
doi: 10.1016/j.jpurol.2014.09.005
Casal Beloy I, Somoza Argibay I, Garcia Gonzalez M, Garcia Novoa MA, Miguez Fortes LM, Dargallo CT (2018) Endoscopic balloon dilatation in primary obstructive megaureter: long-term results. J Pediatr Urol 14(2):167 (e1–e5)
doi: 10.1016/j.jpurol.2017.10.016
Molina Lopez MY, Calama Santiago JA, Penedo Cobos JM, Angulo Madero JM, Gonzalez RC (2008) Evaluation of radiological risk associated to pieloureteral surgery in paediatric patients. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica 21(3):143–148
pubmed: 18756867
Ortiz R, Parente A, Perez-Egido L, Burgos L, Angulo JM (2018) Long-term outcomes in primary obstructive megaureter treated by endoscopic balloon dilation experience after 100 cases. Front Pediatr. 6:275
doi: 10.3389/fped.2018.00275
pubmed: 30345263
pmcid: 6182095
Farrugia MK, Hitchcock R, Radford A, Burki T, Robb A, Murphy F et al (2014) British Association of Paediatric Urologists consensus statement on the management of the primary obstructive megaureter. J Pediatr Urol 10(1):26–33
doi: 10.1016/j.jpurol.2013.09.018
pubmed: 24206785
Braga LH, McGrath M, Farrokhyar F, Jegatheeswaran K, Lorenzo AJ (2018) Society for Fetal Urology classification vs urinary tract dilation grading system for prognostication in prenatal hydronephrosis: a time to resolution analysis. J Urol 199(6):1615–1621
doi: 10.1016/j.juro.2017.11.077
pubmed: 29198999
Angulo JM, Arteaga R, Rodriguez Alarcon J, Calvo MJ (1998) Role of retrograde endoscopic dilatation with balloon and derivation using double pig-tail catheter as an initial treatment for vesico-ureteral junction stenosis in children. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica 11(1):15–18
pubmed: 9662865
Angerri O, Caffaratti J, Garat JM, Villavicencio H (2007) Primary obstructive megaureter: initial experience with endoscopic dilatation. J Endourol Endourol Soc 21(9):999–1004
doi: 10.1089/end.2006.0122
Christman MS, Kasturi S, Lambert SM, Kovell RC, Casale P (2012) Endoscopic management and the role of double stenting for primary obstructive megaureters. J Urol 187(3):1018–1022
doi: 10.1016/j.juro.2011.10.168
pubmed: 22264463
Garcia-Aparicio L, Rodo J, Krauel L, Palazon P, Martin O, Ribo JM (2012) High pressure balloon dilation of the ureterovesical junction—first line approach to treat primary obstructive megaureter? J Urol 187(5):1834–1838
doi: 10.1016/j.juro.2011.12.098
pubmed: 22425047
Torino G, Collura G, Mele E, Garganese MC, Capozza N (2012) Severe primary obstructive megaureter in the first year of life: preliminary experience with endoscopic balloon dilation. J Endourol Endourol Soc 26(4):325–329
doi: 10.1089/end.2011.0399
Kassite I, Renaux Petel M, Chaussy Y, Eyssartier E, Alzahrani K, Sczwarc C et al (2018) High pressure balloon dilatation of primary obstructive megaureter in children: a multicenter study. Front Pediatr 6:329
doi: 10.3389/fped.2018.00329
pubmed: 30430104
pmcid: 6220115
Faraj S, Loubersac T, Graveleau A, Alliot H, Camby C, Leclair MD (2022) Postoperative JJ stent is not necessary after balloon high-pressure endoscopic dilatation of primary obstructive megaureter. J Pediatr Urol 18(3):369 (e1–e7)
doi: 10.1016/j.jpurol.2022.03.028
Romero RM (2019) Management of primary obstructive megaureter by endoscopic high-pressure balloon dilatation. IDEAL framework model as a new tool for systematic review. Front Surg 6:20
doi: 10.3389/fsurg.2019.00020
pubmed: 31058164
pmcid: 6478015