Postoperative JJ stent is not necessary after balloon high-pressure endoscopic dilatation of primary obstructive megaureter

Faraj, S.; Loubersac, T.; Graveleau, Aurélien; Alliot, Hortense; CAMBYdslo, Caroline; Leclair, Marc‐David

doi:10.1016/j.jpurol.2022.03.028

Cited by 10 publications

(20 citation statements)

References 23 publications

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“…Faraj et al recently compared two groups of children undergoing EBD for POMwith and without double J stenting. They reported that the absence of postoperative ureteral drainage seems to decrease postoperative complications rates without altering the success rate (need of further procedure after endoscopic balloon dilatation and the improvement of the ureteral diameter at the postoperative US)(Faraj et al, 2022). We did not observe major postoperative complications, but EBD can be associated with postoperative complications.…”

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confidence: 51%

Efficacy and Safety of Endoscopic Balloon Dilatation for Treatment of Primary Obstruction Megaurater Up to 2 Years of Age

Ahmad¹,

Khan²,

Khan³

2022

PJMHS

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Endoscopic balloon dilatation (EBD) can be performed with different catheters and its durability is still controversial. The study aimed to compare long-term results of EBD performed <20 months of age using balloons of 4 mm vs. 6 mm in diameter. Retrospective study conducted of consecutive patients with unilateral primary obstructive megaureter (POM) undergoing EBD <24 months of age by two surgeons from January 2020 to January 2022. The technique was consistent, but for balloon diameter was 5 mm in group A vs. 6 mm in group B. End-points included peri-operative complications, success rate (improving dilatation and non-obstructive drainage on 9-month scintigraphy), and long-term outcome (need for reimplantation and diameter of retrovesical ureter at last ultrasound). The procedure was completed in all planned patient. Group A included 30 patients and Group B 60 patients. Groups were not significantly different for age (p < 0.09), gender (p < 0.1), laterality (p < 0.7), and preoperative median ureteral diameter (p Z 0.08). No perioperative complications occurred. Four group A patients required a cutting balloon to achieve a satisfactory dilatation of the vesicoureteral junction (p Z 0.009). After a median (range) follow-up of 70 (19e155) months, success rate was 73.3% vs. 83.3% (p Z 0.45), 4/15 group A and 5/30 group B patients required reimplantation within 2 years of EBD. In successful cases, median (range) ureteral diameter at last follow-up was 6 (0-17) mm vs. 5 (0-16) mm, which was significantly better than preoperative value (p Z 0.003 and p < 0.001, respectively), but not significantly different (p Z 0.8) between groups. EBD is an umbrella term that encompasses many technical variations, which can be key for success. Although limited by the small numbers and the comparison of patients treated over two subsequent periods, this is the first study focusing on the role of balloon size. The diameter of the balloon did not influence significantly long-term results, but the 6 mm balloon slightly increased the success rate of EBD to 83.3% and eliminated the need for cutting balloons to achieve a satisfactory dilatation.

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confidence: 51%

Efficacy and Safety of Endoscopic Balloon Dilatation for Treatment of Primary Obstruction Megaurater Up to 2 Years of Age

Ahmad¹,

Khan²,

Khan³

2022

PJMHS

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“…Two authors [ 12 , 14 ] reported that a double-J was not inserted routinely. Faraj S et al [ 17 ] compared those with and without double-J after HPBD. They reported similar success rates in those with double-J stent (75%) and those without (81%).…”

Section: Resultsmentioning

confidence: 99%

“…Out of the 13 studies, five [ 10 , 14 , 19 – 21 ] reported using a single perioperative antibiotics prophylaxis only, while five [ 13 , 15 , 17 , 18 , 22 ] reported continuing antibiotics as chemoprophylaxis after HPBD. Most used prophylaxis until the double- J stent was removed, while Casal Beloy et al [ 13 ] reported continuing antibiotics for only 5 days.…”

Section: Resultsmentioning

confidence: 99%

“…The study by Romero et al [ 21 ] had the minimum risk of bias and the study by Chiarenza et al [ 14 ] had the maximum risk of bias. The risk was high in eight studies [ 10 , 12 – 16 , 18 , 22 ] and moderate in the remaining five studies [ 11 , 17 , 19 – 21 ]. The inter-observer agreement for the quality assessment was good (kappa: 0.88).…”

Section: Resultsmentioning

confidence: 99%

“…Derived from the ten studies [ 11 – 13 , 16 – 22 ] with data on ureteral diameters (POM n = 292), the mean ureteral diameter reduced from preoperative 15.8 mm (range 2–30) to 8.0 mm (0–30) at postoperative follow-up ( p = 0.00009). According to 7 studies [ 11 , 13 , 17 – 21 ] reporting the mean anteroposterior pelvic diameter (AP) pre- and postoperatively (POM n = 245), AP diameter reduced from 16.7 mm (0–46) to 9.7 mm (0–36) ( p = 0.00107).…”

Section: Resultsmentioning

confidence: 99%

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

2023

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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.

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Fetal urinary tract dilation: What to tell the parents

Nulens,

Lorenzo,

Dos Santos

et al. 2023

Prenatal Diagnosis

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Urinary tract dilation (UTD), which refers to the abnormal dilation of the urinary collection system, is the most common finding on prenatal ultrasound and presents with varying severity, presentation, etiology, and prognosis. Prenatal classification and risk stratification aim to prevent postnatal complications, such as urinary tract infections and further kidney dysfunction. Parents expecting a child with UTD should be counseled by a multidisciplinary team consisting of maternal‐fetal medicine specialists, and pediatric urology and nephrology providers. This review summarizes the key points in the diagnostic evaluation and management during the prenatal and initial postnatal period, focusing on the information that should be provided to future parents. We address frequently asked parental questions and concerns that our multidisciplinary clinical practice faces.

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Postoperative JJ stent is not necessary after balloon high-pressure endoscopic dilatation of primary obstructive megaureter

Cited by 10 publications

References 23 publications

Efficacy and Safety of Endoscopic Balloon Dilatation for Treatment of Primary Obstruction Megaurater Up to 2 Years of Age

Efficacy and Safety of Endoscopic Balloon Dilatation for Treatment of Primary Obstruction Megaurater Up to 2 Years of Age

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

Fetal urinary tract dilation: What to tell the parents

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