COMPARATIVE EVALUATION OF ENDOSCOPIC BALLOON DILATATION AND OPEN PYELOPLASTY FOR TREATMENT OF URETEROPELVIC JUNCTION OBSTRUCTION IN CHILDREN
Dmitry Shakhnovskiy, MD, Sergei Zorkin, MD, PhD.
National Medical Research Center for Children's Health, Moscow, Russian Federation.
BACKGROUND: Currently an open or laparoscopic Anderson-Hynes pyeloplasty is considered to be the gold standard treatment for uretero-pelvic junction (UPJ) obstruction, but in era of minimally invasive procedures other surgical options have emerged. The aim of this study was to compare high pressure endoscopic balloon dilatation and an open Anderson-Hynes pyeloplasty for treatment of UPJ obstruction in children. METHODS: From 2015 to 2017 a total of 83 children with a median age of 10 months (range 2 months - 7 years) were treated with endoscopic high-pressure balloon dilatation. During the same period 92 children with a median age of 14 months (range 10 months - 5 years) underwent an open pyeloplasty. Patients with grade 2 and 3 unilateral hydronephrosis were included in the study. Results were evaluated using ultrasonography (US) 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: At follow up in patients with grade 2 hydronephrosis ultrasound pelvic diameter decreased after both pyeloplasty (delta, mm.: -13,1 ± 2,8. p < 0.0001) and balloon dilatation (delta, mm.: -12,3 ± 5,4. p < 0.0001). Washout percentage increased after pyeloplasty (delta, %.: 28,6 ± 8,5. p < 0.0001) and balloon dilatation (delta, %.: 24,9 ± 10,7. p < 0.0001). We observed an increase in differential renal function (DRF) percentage after pyeloplasty (delta, %.: 2,9± 2,5. p<0.0001) and balloon dilatation group (delta, %.: 1,9 ± 2,1. p<0.0001). There were no statistically significant differences in postoperative ultrasound pelvic diameter (p =0,7464), washout percentage (p=0,0448) and DRF (p =0,1604) for evaluated techniques in patients with grade 2 hydronephrosis. In patients with grade 3 hydronephrosis US pelvic diameter was decreased after pyeloplasty (delta, mm.: -17,5 ± 6,1. p < 0.0001) and balloon dilatation (delta, mm.: -8,4 ± 9,1. p < 0.0001). Washout percentage showed an increase after pyeloplasty (delta, %.: 37,6 ± 16,0. p < 0.0001) and balloon dilatation (delta, %.: 20,1 ± 18,4. p < 0.0001). We observed an increase in DRF after pyeloplasty (delta, %.: 4,9 ± 2,8. p < 0.0001) and balloon dilatation (delta, %.: 3,0 ± 3,5. p<0.0001). In patient cohort with grade 3 hydronephrosis we found pyeloplasty more effective than balloon dilatation according to postoperative pelvic diameter (p = 0,0007) and washout percentage (p =0,0017). CONCLUSIONS: Results of this study confirm that balloon dilatation is as effective as pyeloplasty for treatment of UPJ obstruction in grade 2 hydronephrosis. This technique proved its effectiveness for cases of grade 3 hydronephrosis as well. Further studies are needed to establish long term results.
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