Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors
The management of congenital primary obstructive megaureter (POM) is usually conservative, especially during the first year of life. Endoscopic high-pressure balloon dilatation (EHPBD) is indicated when symptoms, increasing dilatation and progressive renal damage are recorded, particularly in childr...
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| Format: | Article |
| Language: | English |
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PAGEPress Publications
2019-12-01
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| Series: | La Pediatria Medica e Chirurgica |
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| Online Access: | http://www.pediatrmedchir.org/index.php/pmc/article/view/219 |
| _version_ | 1811282617795870720 |
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| author | Salvatore Fabio Chiarenza Cosimo Bleve Elisa Zolpi Francesco Battaglino Lorella Fasoli Valeria Bucci |
| author_facet | Salvatore Fabio Chiarenza Cosimo Bleve Elisa Zolpi Francesco Battaglino Lorella Fasoli Valeria Bucci |
| author_sort | Salvatore Fabio Chiarenza |
| collection | DOAJ |
| description | The management of congenital primary obstructive megaureter (POM) is usually conservative, especially during the first year of life. Endoscopic high-pressure balloon dilatation (EHPBD) is indicated when symptoms, increasing dilatation and progressive renal damage are recorded, particularly in children younger than one year of age. We identified and described endoscopic prognostic factors predicting the success or failure of endoscopic dilatation. Thirty-eight patients (33 M;5 F) with POM from 2005-2018 were included. Diagnosis was based on US distal ureter dilatation (>7 mm), obstructive MAG-3 diuretic renogram and absence of vesicoureteral reflux (cystography). 24 patients were under 1 year of age. All patients underwent cystoscopy and high-pressure balloon dilatation with 3,5 Fr dilating balloon, after ascending pyelography. Median follow-up was of 6.5 years. We identified characteristics with poor prognosis: stenotic punctiform ureteral ostium and/or ostium located in a bladder diverticulum (9 pts) and stenotic tract longer than 1 cm (5 pts). The patients with a stenotic tract shorter than 1 cm (18 pts) were divided into two groups: <5 mm (5 pts) and between 5 and 10 mm (13 pts) showed a good response to dilatation. Endoscopic evaluation of ureteral ostium with pneumatic dilatation when possible is a useful diagnostic and therapeutic solution for POM treatment, especially under one year of age. EHPBD is effective in short stenotic tracts (<5 mm). It may also be repeated with good results in intermediate stenotic sections (5 mm-1 cm). According to our preliminary results, the procedure is more effective if performed earlier (3-7 months of life). Greater cohort and longer follow-up are needed to verify the stability of these results. |
| first_indexed | 2024-04-13T01:55:50Z |
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| id | doaj.art-27640633ba1e4401bb4f423d664efe0a |
| institution | Directory Open Access Journal |
| issn | 0391-5387 2420-7748 |
| language | English |
| last_indexed | 2024-04-13T01:55:50Z |
| publishDate | 2019-12-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | La Pediatria Medica e Chirurgica |
| spelling | doaj.art-27640633ba1e4401bb4f423d664efe0a2022-12-22T03:07:45ZengPAGEPress PublicationsLa Pediatria Medica e Chirurgica0391-53872420-77482019-12-0141210.4081/pmc.2019.219Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factorsSalvatore Fabio Chiarenza0Cosimo Bleve1Elisa Zolpi2Francesco Battaglino3Lorella Fasoli4Valeria Bucci5Department of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, VicenzaDepartment of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, VicenzaDepartment of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, VicenzaDepartment of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, VicenzaDepartment of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, VicenzaDepartment of Pediatric Surgery and Pediatric Minimally Invasive Surgery and New Technologies, San Bortolo Hospital, VicenzaThe management of congenital primary obstructive megaureter (POM) is usually conservative, especially during the first year of life. Endoscopic high-pressure balloon dilatation (EHPBD) is indicated when symptoms, increasing dilatation and progressive renal damage are recorded, particularly in children younger than one year of age. We identified and described endoscopic prognostic factors predicting the success or failure of endoscopic dilatation. Thirty-eight patients (33 M;5 F) with POM from 2005-2018 were included. Diagnosis was based on US distal ureter dilatation (>7 mm), obstructive MAG-3 diuretic renogram and absence of vesicoureteral reflux (cystography). 24 patients were under 1 year of age. All patients underwent cystoscopy and high-pressure balloon dilatation with 3,5 Fr dilating balloon, after ascending pyelography. Median follow-up was of 6.5 years. We identified characteristics with poor prognosis: stenotic punctiform ureteral ostium and/or ostium located in a bladder diverticulum (9 pts) and stenotic tract longer than 1 cm (5 pts). The patients with a stenotic tract shorter than 1 cm (18 pts) were divided into two groups: <5 mm (5 pts) and between 5 and 10 mm (13 pts) showed a good response to dilatation. Endoscopic evaluation of ureteral ostium with pneumatic dilatation when possible is a useful diagnostic and therapeutic solution for POM treatment, especially under one year of age. EHPBD is effective in short stenotic tracts (<5 mm). It may also be repeated with good results in intermediate stenotic sections (5 mm-1 cm). According to our preliminary results, the procedure is more effective if performed earlier (3-7 months of life). Greater cohort and longer follow-up are needed to verify the stability of these results.http://www.pediatrmedchir.org/index.php/pmc/article/view/219Endoscopic balloon dilatationmegaureterobstructive megaureter in children. |
| spellingShingle | Salvatore Fabio Chiarenza Cosimo Bleve Elisa Zolpi Francesco Battaglino Lorella Fasoli Valeria Bucci Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors La Pediatria Medica e Chirurgica Endoscopic balloon dilatation megaureter obstructive megaureter in children. |
| title | Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors |
| title_full | Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors |
| title_fullStr | Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors |
| title_full_unstemmed | Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors |
| title_short | Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors |
| title_sort | endoscopic balloon dilatation of primary obstructive megaureter method standardization and predictive prognostic factors |
| topic | Endoscopic balloon dilatation megaureter obstructive megaureter in children. |
| url | http://www.pediatrmedchir.org/index.php/pmc/article/view/219 |
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