AUTHOR=Kassite Ibtissam , Renaux Petel Mariette , Chaussy Yann , Eyssartier Emilie , Alzahrani Khalid , Sczwarc Caroline , Villemagne Thierry , Lardy Hubert , Braik Karim , Binet Aurélien 

TITLE=High Pressure Balloon Dilatation of Primary Obstructive Megaureter in Children: A Multicenter Study

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 6 - 2018

YEAR=2018

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2018.00329

DOI=10.3389/fped.2018.00329

ISSN=2296-2360

ABSTRACT=Abstract
Aim of the study:
We described the initial experience of 4 referral centers in the treatment of primary obstructive megaureter (POM) in children, by high-pressure balloon dilatation (HPBD) of the ureterovesical junction with double JJ stenting. 
We managed a retrospective study, to assess its effectiveness in long-term, and we reviewed the literature concerning this approach.
 
Methods:
We reviewed the medical records of all children who underwent HPBD for POM that require surgical treatment from May 2012 to December 2017 in 4 different institutions. The primary outcome measured was ureterohydronephrosis (UHN) and its degree of improvement after the procedure. Secondary outcomes were postoperative complications and resolution of preoperative symptomatology.

Main results:
42 ureters underwent HPBD for POM in 33 children, with a median age of 14.7 months – (range: 3 months – 15 years). Ureterohydronephrosis improves in 86 % of ureters after one endoscopic treatment. Three cases required a second HPBD. Four patients required surgical treatment for worsening of UHN after endoscopic treatment. The post-operative complication rate was 50 % (21 ureters). In 13 cases (61%), they were related to double J stent. The median follow-up was 24 months (2 months – 5 years) and all patients were symptom-free.

Conclusion:
We reported the first multicenter study and the largest series of children treated with HPBD, with an overall success rate of 92%. Endoscopic treatment can be a definitive treatment of POM since it avoided reimplantation in 90% of cases. Complications are mainly due to double J stent.

Keywords
Ureteral diseases; ureteroscopy; pediatric surgery; hydronephrosis; pyelonephritis