OBJECTIVE: To analyze the usefulness of dilatation in the treatment of ureteropelvic junction obstruction (UPJ) in children < 18 months of age, including newborns and infants.
METHODS: Patients (n = 50; < 18 months of age) were diagnosed using abdominal ultrasound, cystogram, and diuretic renography. Treatment was with endourologic retrograde balloon dilatation under fluoroscopic guidance. The balloons were, in all cases, semicompliant with a profile of 5 mm, 6 mm, or 7 mm. Follow-up was for 42.9 ± 23.2 months (mean ± SD). Double-J stents were inserted postdilatation, the caliber and length depending on the patient's body weight.
RESULTS: Intervention duration was 22 ± 19 minutes. Dilatation was not possible in 5 patients, and pyeloplasty was the alternative treatment. Hospital stay was 24 hours in 44 patients. Analgesic needs were met exclusively by nonsteroidal anti-inflammatory drugs. The double-J stent was withdrawn using cystoscopy and the UPJ was calibrated.Residual stenosis was found in 7 patients. A second dilatation was required in 3 patients 6-18 months after surgery because of the lack of improvement of hydronephrosis. During follow-up, resolution of the hydronephrosis was observed in 45 cases (anterior-posterior diameter of the renal pelvis 7 ± 5 mm). The diuretic renography improved in 45 infants; the shape of the curve being normal in 44 cases and semi-obstructive in 1.
CONCLUSION: We believe that high-pressure balloon dilatation could be a valid and safe option in the minimally invasive treatment of UPJ obstruction in infants. The outcome is acceptable with a low complication rate.
Written by:
Parente A, Angulo JM, Romero RM, Rivas S, Burgos L, Tardáguila A. Are you the author?
Department of Paediatric Urology, Gregorio Marañón University Hospital, Madrid, Spain.
Reference: Urology. 2013 Nov;82(5):1138-43.
doi: 10.1016/j.urology.2013.04.072
PubMed Abstract
PMID: 23992967
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