Justification of primary endoscopic treatment for obstructive megaureter.
Zukhra Sabirzyanova, MD, Andrey Yu Pavlov, MD, PhD, professor, Gevorg Simonyan, MD.
Russian scientific research center of roentgenradiology, Moscow, Russian Federation.
BACKGROUND: During the last years endoscopic treatment of primary obstructive megaureter, especially endoscopic balloon dilatation, are used widely. At the same time, we have a long time follow up of passive endoscopic dilatation of ureterovesical junction with internal stents replacement. However, there are no clear arguments proving the effects.
The aim of this study was to access the effects of endoscopic dilatation of UVJ with prolog stenting depending on the age of patient, degree of upper urinary tract dilatation, urodinamic disorders and kidney function for substantiate the minimal invasive treatment.
METHODS: 260 patients in the age from 3 month till 10 years with primary obstructive megaureter were treated endoscopically with passive UVJ dilatation and prolonged stenting during from 1 till 3 month. Ultrasound, DMSA and MAC3 dynamic scintigraphy were done in all of them for accessing the severity level of disease.
RESULTS: 160 of them have changes in urine analysis or acute obstructive pyelonephritis. In 45 renal function was poor, with its decreasing on 40-60%.
Primary follow up 1-2 years over the treatment shows the improving kidneys function by scintigraphy in all patients. There were no symptoms of infection in all of them during the all-time after the stent removing. Moreover, there was significant improving of upper urinary tract urodynamic in 170, in others the obstructive disorders remained. There were significant correlation between the age of patient and urodynamic rehabilitation- it was improved in 90% infants, nevertheless among the patients elder than 5 years old it was improved only in 10%.
CONCLUSIONS: it must be two different reasons for primary endoscopic correction of obstructive megaureter. At first, this method is a kind of internal urine diversion for kidney function rehabilitation and urine sanation. In another cases it may be primary ureteroplasty, which can improve urodynamic of upper urinary tract, especially in young children.
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