Olugbenga Awolaran , Ijeoma Nwachukwu , Anu Paul , Massimo Garriboli , Arash Taghizadeh , Sara Lobo , Karim Awad , Kate Burns , Mohamed Shalaby , Mark Woodward , Pankaj Mishra
{"title":"Endoscopic balloon dilatation of primary obstructive megaureter: An effective first line management in children","authors":"Olugbenga Awolaran , Ijeoma Nwachukwu , Anu Paul , Massimo Garriboli , Arash Taghizadeh , Sara Lobo , Karim Awad , Kate Burns , Mohamed Shalaby , Mark Woodward , Pankaj Mishra","doi":"10.1016/j.jpurol.2024.09.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim</h3><div>This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children.</div></div><div><h3>Methods</h3><div>Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period.</div></div><div><h3>Results</h3><div>55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25 mm (p = 0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation.</div></div><div><h3>Discussion</h3><div>Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25 mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature.</div></div><div><h3>Conclusions</h3><div>This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.<span><div><span><span><p><span>Summary table</span>. </p></span></span><div><table><thead><tr><td><span>Empty Cell</span></td><th>P-value</th></tr></thead><tbody><tr><th>Outcomes based on age (median post-op APD)</th></tr><tr><td><ul><li><span></span><span><div>- <12months</div></span></li></ul></td><td>20 units (13 mm)</td><td>0.433</td></tr><tr><td><ul><li><span></span><span><div>- >/ = 12mo</div></span></li></ul></td><td>41 units (13 mm)</td></tr><tr><th>Outcomes based on severity of DUD diameter (median post-op DUD)</th></tr><tr><td><ul><li><span></span><span><div>- <25 mm</div></span></li></ul></td><td>87% (11 mm)</td><td>0.701</td></tr><tr><td><ul><li><span></span><span><div>- >/ = 25 mm</div></span></li></ul></td><td>13% (7 mm)</td></tr><tr><th>Further interventions (10 children)</th></tr><tr><td><ul><li><span></span><span><div>- Repeat balloon dilatation</div></span></li></ul></td><td>5</td><td></td></tr><tr><td><ul><li><span></span><span><div>- Ureteric re-implantation</div></span></li></ul></td><td>3</td></tr><tr><td><ul><li><span></span><span><div>- Ureteroscopy + laser for stent encrustation</div></span></li></ul></td><td>1</td></tr><tr><td><ul><li><span></span><span><div>- Endoscopic treatment of VUR</div></span></li></ul></td><td>1</td></tr><tr><th>Procedure related complications (5 children)</th></tr><tr><td><ul><li><span></span><span><div>- Post-op VUR</div></span></li></ul></td><td>2</td><td></td></tr><tr><td><ul><li><span></span><span><div>- Stent encrustation</div></span></li></ul></td><td>1</td></tr><tr><td><ul><li><span></span><span><div>- Stent migration</div></span></li></ul></td><td>1</td></tr><tr><td><ul><li><span></span><span><div>- Failure to cannulate ureteric orifice</div></span></li></ul></td><td>1</td></tr><tr><td><ul><li><span></span><span><div>- Post-op UTI</div></span></li></ul></td><td>1</td></tr></tbody></table></div></div></span></div></div>","PeriodicalId":16747,"journal":{"name":"Journal of Pediatric Urology","volume":"21 1","pages":"Pages 124-129"},"PeriodicalIF":2.0000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Urology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1477513124004613","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Aim
This study evaluates outcomes of endoscopic balloon dilatation (EBD) in the management of primary obstructive megaureter (POM) in children.
Methods
Retrospective data between 2013 and 2023 from two tertiary paediatric surgical centres in the UK were reviewed. Pre and post-operative clinical and imaging parameters of children managed with EBD were assessed. Failure of procedure was defined as requiring further intervention due to persistent/recurrent symptoms, upper tract dilatation and/or obstruction on MAG3 over the follow up period.
Results
55 children with 61 renal units were evaluated. Median age at treatment was 18 months with a median follow up of 24 months. There was significant reduction in upper tract ultrasound measurements following balloon dilatation but there was no significant difference between the pre and post-operative renal function on MAG3. No significance difference was demonstrated when the outcomes of cutting and non-cutting balloons were compared. No significant difference was shown when outcomes after EBD were compared between infants vs older children as well as ureteric dilatation less than or over 25 mm (p = 0.841). 87% were successfully treated with a single dilatation and this increased to 95% after second dilatation. The remaining 5% had ureteric re-implantation.
Discussion
Although a retrospective study, the patient population is relatively large. 87% success rate shown after EBD is comparable to similar studies. It has been suggested that children less than 12months and those with severe ureteric dilatation (>25 mm) may not be suitable for EBD. No significant difference was demonstrated when the outcomes of these categories of children were compared to other children with POM. All of the patients that had repeat balloon dilatation required no further intervention, a finding that has so far not been well evaluated in available literature.
Conclusions
This study demonstrates 87% success rate after single EBD in children with POM and this outcome increased to 95% following a second dilatation. EBD is shown to be an effective definitive surgical management option of POM. It can be safely offered as first line management in all patient groups and repeated if no initial response.
Summary table.
Empty Cell
P-value
Outcomes based on age (median post-op APD)
- <12months
20 units (13 mm)
0.433
- >/ = 12mo
41 units (13 mm)
Outcomes based on severity of DUD diameter (median post-op DUD)
期刊介绍：
The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review.
It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty.
It publishes regular reviews of pediatric urological articles appearing in other journals.
It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty.
It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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