High-pressure balloon dilatation of primary obstructive megaureter in children: a systematic review

Abstract

Objective We aimed to evaluate the effectiveness and complication rates of endoscopic high-pressure balloon dilatation (HPBD) in treating primary obstructive megaureter (POM) in children based on current literature. Specifically, we wanted to clarify the evidence on the use of HPBD in children under one year of age. Methods A systematic search of the literature was performed via several databases. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed. The primary outcomes studied in this systematic review were the effectiveness of HBPD in relieving obstruction and reducing hydroureteronephrosis in children. The secondary outcome was to study the complication rate of endoscopic high-pressure balloon dilatation. Studies that reported one or both of these outcomes (n = 13) were considered eligible for inclusion in this review. Results HPBD significantly decreased both ureteral diameter (15.8 mm [range 2–30] to 8.0 mm [0–30], p = 0.00009) and anteroposterior diameter of renal pelvis (16.7 mm [0–46] to 9.7 mm [0–36], p = 0.00107). The success rate was 71% after one HPBD and 79% after two HPBD. The median follow-up time was 3.6 years (interquartile range 2.2–6.4 years). A complication rate of 33% was observed, but no Clavien–Dindo grade IV–V complications were reported. Postoperative infections and VUR were detected in 12% and 7.8% of cases, respectively. For children under one year of age, outcomes of HPBD seem to be similar to those in older children. Conclusions This study indicates that HPBD appears to be safe and can be used as the first-line treatment for symptomatic POM. Further comparative studies are needed addressing the effect of treatment in infants, and also long-term outcomes of the treatment. Due to the nature of POM, identifying those patients who will benefit from HPBD remains challenging.

Should a Refluxing Internal Diversion Be Considered a Temporizing Procedure? Extended Follow-up and Outcomes After Side-to-Side Ureterovesicostomy for Primary Obstructive Megaureter in Young Children

“…19 However, despite the perceived benefits of a fully endoscopic intervention, there are some drawbacks. These include the overall success rate (which can be as low as 71%, based on a recent systematic review 20 ), the risk of secondary VUR, inability to gain ureteral access in all cases, difficult stent deployment in a tortuous ureter, stent displacement, and risk of recurrent ureteral stenosis. 21 In addition, the procedure requires the use of fluoroscopy and, depending on the caliber and length of the stenotic segment, specialized equipment for access and dilation.…”

Primary non-refluxing megaureter: Natural history, follow-up and treatment

“…Recently, Ripatti et al suggested that HPBD seems safe and could serve as the primary treatment for symptomatic PMU, yet additional comparative studies are required to evaluate its efficacy in infants and its long-term effects, with the challenge remaining in accurately identifying patients who would benefit from HPBD due to the complex nature of PMU [ 49 ].…”