Society For Pediatric Urology

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Dmitry Shakhnovskiy, MD, Sergei Zorkin, MD, PhD, Viktor Gubarev, MD.
National Medical Research Center for Children's Health, Moscow, Russian Federation.

BACKGROUND: Today there is a growing worldwide trend toward minimally invasive treatment of such common clinical condition in children as hydronephrosis. Endoscopic balloon dilatation was shown to be effective in short term follow-up. The aim of our study was to evaluate the long-term efficiency of this procedure for treatment of children with hydronephrosis.
METHODS: From 2015 to 2017 a total of 83 children (56 boys and 27 girls) with a median age of 10 months (range 2 months - 7 years) were treated with endoscopic high-pressure balloon dilatation. In the study were included patients with unilateral hydronephrosis with ureteropelvic junction obstruction . We employed a semicompliant balloons with 4 mm. profile. In all cases we placed double-J stent of 5 Fr. diameter after a procedure. Results were evaluated using ultrasonography and MAG-3 renogram 6 months following the procedure. Positive outcome we considered to be a decrease in pelvic anteroposterior diameter and an improvement of drainage according to renogram.
RESULTS: Median duration of the procedure was 28 minutes (range 22-38). In this series dilatation was not possible in 3 cases and these patients underwent a pyeloplasty. There were no intraoperative complications. Analgesic therapy was based exclusively on a nonsteroidal anti-inflammatory drugs. 6 patients developed a febrile urinary tract infection after a procedure. Double-J stents were removed cystoscopically in 6 weeks. At 6 months follow-up 61 out of 83 patients (73,5%) had a non-obstructive curve and an increase in differential renal function (DRF) percentage on MAG-3 renogram. All these patients also showed a decrease of pelvic diameter according to ultrasound examination and maintained their results on the first year follow up. The median follow up was 1 year 8 months (range 1 year 2 months to 2 years 3 months). Postoperative ultrasound pelvic diameters at 6 months after surgery (median 8 mm., range 3 mm.-35 mm.) were significantly lower then preoperatively (median 24 mm., range 14 mm.-36 mm., p-value <0,0001 according to Wilcoxon test). Postoperative washout percentage on MAG-3 renogram at 6 months after surgery (median 60%, range 16%-88%) showed a significant increase in comparison to preoperative figures (median 39%, range 14%-71%, p-value <0,0001 according to Wilcoxon test). Also we observed a significant increase in DRF percentage at 6 months after procedure (median 46 %, range 29%-56%, p-value <0,0001 according to Wilcoxon test) in comparison to preoperative (median 42%, range 29%-52%) CONCLUSIONS:
Results of this study confirm that endoscopic high-pressure balloon dilatation is a safe option for treatment of hydronephrosis in children. It demonstrates good and sustainable long-term outcome with no significant complications. Further studies are needed to prove the stability of positive outcome over longer period of time.

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