ENDOSCOPIC BALLOON DILATATION FOR TREATMENT OF PRIMARY OBSTRUCTIVE MEGAURETER IN CHILDREN: PREDICTORS OF SUCCESS
Dmitry Shakhnovskiy, MD, Sergei Zorkin, MD, PhD, Alexandra Galuzinskaya, MD, Nadezhda Komarova, MD.
National Medical Research Center for Children's Health, Moscow, Russian Federation.
BACKGROUND: Currently there is no widely accepted treatment strategy for primary obstructive megaureter cases. Since the first time application in 1998 endoscopic high-pressure balloon dilatation (EBD) has been shown to be an effective option for obstructive megaureter treatement. The aim of this study was to identify and assess predictors of success for this treatment option in children. METHODS: From 2018 to 2021 a total of 47 children with a median age of 12 months were treated by EBD. Results were evaluated using ultrasonography (US) and MAG-3 renogram at 6 and 12 months following the procedure. EBD was performed using 3 Fr. semicompliant balloon catheters with 4 mm. balloon diameter, followed by JJ stent placement. Stents were removed in 6 weeks. Positive outcome we considered to be a decrease in pelvic anteroposterior and distal ureteral diameters and an improvement of drainage according to renogram. RESULTS: US pelvic and ureteral diameters were significantly decreased after EBD (delta, -46.6%, p <0.0001 and -54,7%, p < 0.0001 respectively). Washout halftime also showed a decrease (delta, -70,1%. p < 0.0001). In this patient cohort EBD had a 85,1% success rate. EBD was unsuccessful in 7 cases (14.9%). Secondary vesicoureteral reflux was found in 1 case (2,1%). We identified three features of stenotic part of ureter being predictors of treatment outcome. Among them area of stenosis lower than 96,8% was the most predictive for good outcome (p <0.0001). Length of stenotic tract under 1,8 mm. also predicted good outcome with lower predictive value (p<0,0025). We found stenosis diameter more than 0,7 mm. to have the least predictive value of good treatment outcome (p<0,0059). CONCLUSIONS: Results of this study confirm that EBD proved its effectiveness for vast majority of primary obstructive megaureter cases with relatively minimal complications. We also identified predictors of success for EBD, with area of stenosis being the most important of them. Further studies are needed to establish long term results.
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