Severe primary obstructive megaureter in the first year of life: Preliminary experience with endoscopic balloon dilation

Giovanni Torino, Giuseppe Collura, Ermelinda Mele, Maria Carmen Garganese, Nicola Capozza

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Abstract

Background and Purpose: Although conservative management is indicated in most cases of primary obstructed megaureter (POM), surgery is still indicated when POM is associated with increasing dilation, symptoms, or progressive renal damage. Surgery is associated with a significant rate of complications, however, especially in the case of very large ureter in the first year of life. A valid alternative could be endoscopic high pressure balloon dilation (EHPBD) of the vesicoureteral junction (VUJ). We report the first experience with EHPBD in patients under 1 year of age who were affected by severe POM. Patients and Methods: Five patients, aged between 6 and 12 months, were treated with EHPBD. In all patients, preoperative renal ultrasonography showed a distal ureteral dilation ≥15 mm that increased at later evaluations; an obstructive pattern was detected by preoperative diuretic renography. An 8-9,8 F cystoscope, and a 3F balloon catheter (balloon maximum diameter 4 mm) was used. The VUJ was dilated for 5 minutes at 12 to 14 atm. A 4.7F Double-J stent was then positioned and left in place for 6 to 8 weeks. Ultrasonography was performed every 3 months, and renography and voiding cystourethrography the fourth month after the EHPBD. Results: No operative complications were observed. All the patients showed an improvement at the ultrasonography postoperative follow-up, and there was no evidence of obstruction/reflux at the postoperative check up. Conclusions: Our preliminary results seem to indicate that EHPBD is a feasible, safe, and successful procedure. It could play a role as a minimally invasive alternative to open surgery in cases of POM that necessitate intervention in the first year of life. Longer follow-up is necessary to verify the stability of these results.

Original languageEnglish
Pages (from-to)325-329
Number of pages5
JournalJournal of Endourology
Volume26
Issue number4
DOIs
Publication statusPublished - Apr 1 2012

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ASJC Scopus subject areas

  • Urology

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