title: Severe primary obstructive megaureter in the first year of life: preliminary experience with endoscopic balloon dilation.
abstract: OBJECTIVE
  Although conservative management is indicated in most cases of primary obstructed megaureter (POM), surgery is still indicated when POM is associated with increasing dilation, symptoms, or progressive renal damage. Surgery is associated with a significant rate of complications, however, especially in the case of very large ureter in the first year of life. A valid alternative could be endoscopic high pressure balloon dilation (EHPBD) of the vesicoureteral junction (VUJ). We report the first experience with EHPBD in patients under 1 year of age who were affected by severe POM.
  
  
  METHODS
  Five patients, aged between 6 and 12 months, were treated with EHPBD. In all patients, preoperative renal ultrasonography showed a distal ureteral dilation ≥15 mm that increased at later evaluations; an obstructive pattern was detected by preoperative diuretic renography. An 8-9,8 F cystoscope, and a 3F balloon catheter (balloon maximum diameter 4 mm) was used. The VUJ was dilated for 5 minutes at 12 to 14 atm. A 4.7F Double-J stent was then positioned and left in place for 6 to 8 weeks. Ultrasonography was performed every 3 months, and renography and voiding cystourethrography the fourth month after the EHPBD.
  
  
  RESULTS
  No operative complications were observed. All the patients showed an improvement at the ultrasonography postoperative follow-up, and there was no evidence of obstruction/reflux at the postoperative check up.
  
  
  CONCLUSIONS
  Our preliminary results seem to indicate that EHPBD is a feasible, safe, and successful procedure. It could play a role as a minimally invasive alternative to open surgery in cases of POM that necessitate intervention in the first year of life. Longer follow-up is necessary to verify the stability of these results.
authors: Surgical Unit of the Pediatric Renal Transplant and Correlated Pathologies, Bambino Gesù Children's Hospital and Research Institute, Piazza S. Onofrio no. 4, Rome, Italy. giovannitorino1@libero.it
authors: Giovanni
authors: G
authors: Torino
authors: Giuseppe
authors: G
authors: Collura
authors: Ermelinda
authors: E
authors: Mele
authors: Maria Carmen
authors: MC
authors: Garganese
authors: Nicola
authors: N
authors: Capozza
mesh_terms: D002404:Catheterization / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011312:Pressure; D011859:Radiography; D011866:Radioisotope Renography; D016896:Treatment Outcome; D014463:Ultrasonography; D014513:Ureter / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D014517:Ureteral Obstruction / Q000000981:diagnostic imaging / Q000601:surgery*