Endoscopic management and the role of double stenting for primary obstructive megaureters - Abstract

PURPOSE:We determined the efficacy and potential complications of endoscopic incision and balloon dilation with double stenting for the treatment of primary obstructive megaureter in children.

MATERIALS AND METHODS: We prospectively reviewed cases of primary obstructive megaureter requiring repair due to pyelonephritis, renal calculi and/or loss of renal function. A total of 17 patients were identified as candidates for endoscopy. Infants were excluded from study. All patients underwent cystoscopy and retrograde ureteropyelography to start the procedure. In segments less than 2 cm balloon dilation was performed, and for those 2 to 3 cm laser incision was added. Two ureteral stents were placed within the ureter simultaneously and left indwelling for 8 weeks. Imaging was performed 3 months after stent removal and repeated 2 years following intervention.

RESULTS: Mean patient age was 7.0 years (range 3 to 12). Of the patients 12 had marked improvement of hydroureteronephrosis on renal and bladder ultrasound. The remaining 5 patients had some improvement on renal and bladder ultrasound, and underwent magnetic resonance urography revealing no evidence of obstruction. All patients were followed for at least 2 years postoperatively and were noted to be symptom-free with stable imaging during the observation period.

CONCLUSIONS: Endoscopic management appears to be an alternative to reimplantation for primary obstructive megaureter with a narrowed segment shorter than 3 cm. Double stenting seems to be effective in maintaining patency of the neo-orifice. Followup into adolescence is needed.

Written by:
Christman MS, Kasturi S, Lambert SM, Kovell RC, Casale P. Are you the author?
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Reference: J Urol. 2012 Mar;187(3):1018-22.
doi: 10.1016/j.juro.2011.10.168

PubMed Abstract
PMID: 22264463

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