Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center
Autor(a) principal: | |
---|---|
Data de Publicação: | 2017 |
Outros Autores: | , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.24915/aup.34.1-2.41 |
Resumo: | Introduction: Congenital obstructive megaureter may be treated with endoscopic balloon dilatation, particularly in children under one year of age. We report our experience over a six year period. Patients and methods: All patients with diagnosis of primary obstructive megaureter (POM) treated with endoscopic balloon dilatation from 2009 to 2014 (6 years) were included. The diagnosis of POM was based on dilatation of the distal ureter greater than 7 mm, obstructive curve on MAG 3 diuretic renogram and absence of vesicoureteral reflux (VUR). After diagnosis, conservative management was maintained with antibiotic prophylaxis in all patients. The indications for surgery were a combination of clinical, ultrasonographic and renographic findings. Under general anesthesia and after retrograde ureteropielography, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A double-J catheter was positioned. Follow-up was performed with ultrasonography and diuretic renogram. The success of the intervention was defined by improvement of HUN (at least 2 grades). Results: A total of nine patients underwent this procedure on a single ureter, two girls and seven boys, with a mean age of 7. 6 months (range 1-14) at the intervention. Five were left sided and four were right sided. All patients had prenatal diagnosis of hydroureteronephrosis (HUN). No patients were lost to follow-up (average 46.7 months). They all had HUN greater than grade 3 and preoperative MAG3 diuretic renogram was obstructive in all cases. Mean differential function of the affected kidney was 46.2% (range 40-53%). The main indication for surgical treatment was progressive HUN. All patients were treated endoscopically with no intraoperative complications. Ultrasound showed improvement of the HUN in six patients (66.7%). Three patients were reimplanted (33.3%). The mean differential renal function (DRF) after the procedure was 47.4% (range 41-53%). At the latest follow-up assessment, all patients remained asymptomatic. Discussion: Endoscopic balloon dilatation is a useful option in the management of POM requiring surgical intervention and may be considered first line treatment in small children. |
id |
RCAP_66fc61934c19e281ea1b2a0be06f2747 |
---|---|
oai_identifier_str |
oai:oai.actaurologicaportuguesa.com:article/41 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a CenterDilatação Endoscópica de Balão para Tratamento de Megaureter Obstrutivo Primário: Experiência de um CentroChildConstriction, PathologicDilatationEndoscopyHydronephrosisUreter/abnormalitiesUreteral ObstructionCriançaConstrição PatológicaDilataçãoEndoscopiaHidronefroseObstrução UreteralUreter/anomalias congénitasIntroduction: Congenital obstructive megaureter may be treated with endoscopic balloon dilatation, particularly in children under one year of age. We report our experience over a six year period. Patients and methods: All patients with diagnosis of primary obstructive megaureter (POM) treated with endoscopic balloon dilatation from 2009 to 2014 (6 years) were included. The diagnosis of POM was based on dilatation of the distal ureter greater than 7 mm, obstructive curve on MAG 3 diuretic renogram and absence of vesicoureteral reflux (VUR). After diagnosis, conservative management was maintained with antibiotic prophylaxis in all patients. The indications for surgery were a combination of clinical, ultrasonographic and renographic findings. Under general anesthesia and after retrograde ureteropielography, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A double-J catheter was positioned. Follow-up was performed with ultrasonography and diuretic renogram. The success of the intervention was defined by improvement of HUN (at least 2 grades). Results: A total of nine patients underwent this procedure on a single ureter, two girls and seven boys, with a mean age of 7. 6 months (range 1-14) at the intervention. Five were left sided and four were right sided. All patients had prenatal diagnosis of hydroureteronephrosis (HUN). No patients were lost to follow-up (average 46.7 months). They all had HUN greater than grade 3 and preoperative MAG3 diuretic renogram was obstructive in all cases. Mean differential function of the affected kidney was 46.2% (range 40-53%). The main indication for surgical treatment was progressive HUN. All patients were treated endoscopically with no intraoperative complications. Ultrasound showed improvement of the HUN in six patients (66.7%). Three patients were reimplanted (33.3%). The mean differential renal function (DRF) after the procedure was 47.4% (range 41-53%). At the latest follow-up assessment, all patients remained asymptomatic. Discussion: Endoscopic balloon dilatation is a useful option in the management of POM requiring surgical intervention and may be considered first line treatment in small children.Introdução: O megauretero obstrutivo congénito pode ser tratado por dilatação endoscópica com balão, especialmente nas crianças com menos de um ano de idade. Este trabalho revela a nossa experiência num período de seis anos. Doentes e métodos: Todos os doentes com o diagnóstico de megauretero obstrutivo congénito submetidos a dilatação endoscópica com balão foram incluídos, no período de tempo compreendido entre 2009 e 2014 (seis anos). O diagnóstico baseou-se na identificação de dilatação do uretero distal superior a 7 mm, padrão obstrutivo no renograma MAG3 e ausência de refluxo vesico-ureteral. Após o diagnóstico, adoptou-se uma atitude conservadora com início de profilaxia antibiótica e vigilância ecográfica em todos os doentes. A indicação cirúrgica resultou de um conjunto de achados clínicos, ecográficos e renográficos. Sob anestesia geral, e após pielografia retrógrada, foi realizada dilatação endoscópica da junção uretero-vesical sob visão directa e controlo fluoroscópico até ao desaparecimento do anel estenótico, colocando-se no final um stent duplo J. O seguimento foi feito com controlo ecográfico e renograma. O sucesso da intervenção cirúrgica foi definido como uma melhoria no grau de hidroureteronefrose (pelo menos 2 graus). Resultados: No total, 9 doentes foram intervencionados num só uretero, duas meninas e sete meninos, com idade média de 7.6 meses (entre 1-14) na data da cirurgia. Cinco foram no lado esquerdo e quatro no lado direito. Todos os doentes tinham diagnóstico pré-natal de hidroureteronefrose. Nenhum doente foi perdido no seguimento (média 46.7 meses). Todos tinham hidroureteronefrose de grau superior ou igual a 3 e padrão obstrutivo no renograma MAG3. A função relativa média do rim homolateral foi 46.2% (entre 40-53%). A principal indicação cirúrgica foi o agravamento da hidroureteronefrose durante a vigilância ecográfica. Não existiram complicações intra-operatórias. A ecografia mostrou melhoria da hidroureteronefrose em 6 doentes (66.7%). Três doentes foram re-implantados (33.3%) A função relativa média após a cirurgia foi 47.4% (entre 41-53%). Na consulta de seguimento mais recente, todos os doentes estavam assintomáticos. Discussão: A dilatação endoscópica com balão é uma opção na abordagem do megauretero obstrutivo primário com indicação operatória e pode ser considerado como tratamento de primeira linha nas crianças com menos de um ano de idade.Associação Portuguesa de Urologia2017-07-20T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.24915/aup.34.1-2.41oai:oai.actaurologicaportuguesa.com:article/41Acta Urológica Portuguesa; Vol. 34 No. 1-2 (2017): January-March; April-June; 14-18Acta Urológica Portuguesa; v. 34 n. 1-2 (2017): janeiro-março; abril-junho; 14-182387-04192341-4022reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://www.actaurologicaportuguesa.com/index.php/aup/article/view/41https://doi.org/10.24915/aup.34.1-2.41http://www.actaurologicaportuguesa.com/index.php/aup/article/view/41/14Morão, SofiaPratas Vital, VandaCardoso, DinorahAlves, FátimaCatela Mota, FilipePascoal, Joãoinfo:eu-repo/semantics/openAccess2022-09-21T09:04:46Zoai:oai.actaurologicaportuguesa.com:article/41Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T15:55:52.846704Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center Dilatação Endoscópica de Balão para Tratamento de Megaureter Obstrutivo Primário: Experiência de um Centro |
title |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center |
spellingShingle |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center Morão, Sofia Child Constriction, Pathologic Dilatation Endoscopy Hydronephrosis Ureter/abnormalities Ureteral Obstruction Criança Constrição Patológica Dilatação Endoscopia Hidronefrose Obstrução Ureteral Ureter/anomalias congénitas |
title_short |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center |
title_full |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center |
title_fullStr |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center |
title_full_unstemmed |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center |
title_sort |
Endoscopic Balloon Dilatation for Treatment of Primary Obstructive Megaureter: Experience of a Center |
author |
Morão, Sofia |
author_facet |
Morão, Sofia Pratas Vital, Vanda Cardoso, Dinorah Alves, Fátima Catela Mota, Filipe Pascoal, João |
author_role |
author |
author2 |
Pratas Vital, Vanda Cardoso, Dinorah Alves, Fátima Catela Mota, Filipe Pascoal, João |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Morão, Sofia Pratas Vital, Vanda Cardoso, Dinorah Alves, Fátima Catela Mota, Filipe Pascoal, João |
dc.subject.por.fl_str_mv |
Child Constriction, Pathologic Dilatation Endoscopy Hydronephrosis Ureter/abnormalities Ureteral Obstruction Criança Constrição Patológica Dilatação Endoscopia Hidronefrose Obstrução Ureteral Ureter/anomalias congénitas |
topic |
Child Constriction, Pathologic Dilatation Endoscopy Hydronephrosis Ureter/abnormalities Ureteral Obstruction Criança Constrição Patológica Dilatação Endoscopia Hidronefrose Obstrução Ureteral Ureter/anomalias congénitas |
description |
Introduction: Congenital obstructive megaureter may be treated with endoscopic balloon dilatation, particularly in children under one year of age. We report our experience over a six year period. Patients and methods: All patients with diagnosis of primary obstructive megaureter (POM) treated with endoscopic balloon dilatation from 2009 to 2014 (6 years) were included. The diagnosis of POM was based on dilatation of the distal ureter greater than 7 mm, obstructive curve on MAG 3 diuretic renogram and absence of vesicoureteral reflux (VUR). After diagnosis, conservative management was maintained with antibiotic prophylaxis in all patients. The indications for surgery were a combination of clinical, ultrasonographic and renographic findings. Under general anesthesia and after retrograde ureteropielography, high pressure balloon dilation of the ureterovesical junction was performed under direct and fluoroscopic vision until the disappearance of the narrowed ring. A double-J catheter was positioned. Follow-up was performed with ultrasonography and diuretic renogram. The success of the intervention was defined by improvement of HUN (at least 2 grades). Results: A total of nine patients underwent this procedure on a single ureter, two girls and seven boys, with a mean age of 7. 6 months (range 1-14) at the intervention. Five were left sided and four were right sided. All patients had prenatal diagnosis of hydroureteronephrosis (HUN). No patients were lost to follow-up (average 46.7 months). They all had HUN greater than grade 3 and preoperative MAG3 diuretic renogram was obstructive in all cases. Mean differential function of the affected kidney was 46.2% (range 40-53%). The main indication for surgical treatment was progressive HUN. All patients were treated endoscopically with no intraoperative complications. Ultrasound showed improvement of the HUN in six patients (66.7%). Three patients were reimplanted (33.3%). The mean differential renal function (DRF) after the procedure was 47.4% (range 41-53%). At the latest follow-up assessment, all patients remained asymptomatic. Discussion: Endoscopic balloon dilatation is a useful option in the management of POM requiring surgical intervention and may be considered first line treatment in small children. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-07-20T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.24915/aup.34.1-2.41 oai:oai.actaurologicaportuguesa.com:article/41 |
url |
https://doi.org/10.24915/aup.34.1-2.41 |
identifier_str_mv |
oai:oai.actaurologicaportuguesa.com:article/41 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://www.actaurologicaportuguesa.com/index.php/aup/article/view/41 https://doi.org/10.24915/aup.34.1-2.41 http://www.actaurologicaportuguesa.com/index.php/aup/article/view/41/14 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Associação Portuguesa de Urologia |
publisher.none.fl_str_mv |
Associação Portuguesa de Urologia |
dc.source.none.fl_str_mv |
Acta Urológica Portuguesa; Vol. 34 No. 1-2 (2017): January-March; April-June; 14-18 Acta Urológica Portuguesa; v. 34 n. 1-2 (2017): janeiro-março; abril-junho; 14-18 2387-0419 2341-4022 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799130427656503296 |