Paediatric Urology Unit, Hospital Universitario Gregorio Marañon , Madrid, Spain .
J Endourol. 2014 May;28(5):517-23. doi: 10.1089/end.2013.0210. Epub 2014 Feb 14.
There is a growing interest in minimally invasive treatment of primary obstructive megaureter (POM) in children. The absence of long-term follow-up data, however, makes it difficult to establish the indication for an endoscopic approach. The aim of our study is to determine the long-term efficacy of endourologic high-pressure balloon dilation of the vesicoureteral junction (VUJ) in children with POM that necessitates surgical treatment.
We retrospectively reviewed the clinical records from children with POM who were treated with endourologic high-pressure balloon dilation of the VUJ from March 2003 to April 2010. To determine the long-term, a cohort study was conducted in November 2011. Endourologic dilation of the VUJ was performed with a semicompliant high-pressure balloon (2.7 FG) with a minimum balloon size of 3 mm, followed by placement of a Double-J stent.
We have treated 29 (32 renal units, left [n=16], right [n=10] and bilateral [n=3]) children with a diagnosis of POM within this period. The median age at the time of the endourologic treatment was 4.04 months (range 1.6-39 months). In three cases, an open ureteral reimplantation was needed, in two cases because of intraoperative technical failure and postoperative Double-J stent migration in one patient. The 26 children (29 renal units) who had a successful endourologic dilation of the VUJ were followed with ultrasonography and MAG-3-Lasix (furosemide) studies that showed a progressive improvement of both the ureterohydronephrosis and drainage in the first 18 months in 20 patients (23 renal units) (69%). In two patients who were treated with a 3 mm balloon, a further dilation was needed, with an excellent outcome. The cohort study (at a median follow-up of 47 months) showed that in all patients who had a good outcome at the 18-month follow-up after endourologic balloon dilation remained asymptomatic with resolution of ureterohydronephrosis on the US and good drainage on the renogram, in the children with some persistent hydronephrosis.
Our study shows that children with POM who were treated with high-pressure ballon dilation of the VUJ who have satisfactory appearance at 18 months maintain these results over time.
目前，人们对儿童原发性梗阻性巨输尿管症（POM）的微创治疗越来越感兴趣。然而，由于缺乏长期随访数据，因此难以确定内镜治疗的适应证。我们的研究旨在确定需要手术治疗的 POM 患儿行腔内泌尿外科高压球囊扩张治疗肾盂输尿管连接部（VUJ）的长期疗效。
我们回顾性分析了 2003 年 3 月至 2010 年 4 月期间接受腔内泌尿外科高压球囊扩张 VUJ 治疗的 POM 患儿的临床资料。为了确定长期疗效，我们于 2011 年 11 月进行了队列研究。使用半顺应性高压球囊（2.7 FG）进行 VUJ 腔内扩张，球囊最小尺寸为 3mm，随后放置双 J 支架。
在此期间，我们共治疗了 29 例（32 个肾脏单位，左侧[16 例]、右侧[10 例]和双侧[3 例]）诊断为 POM 的患儿。腔内治疗时的中位年龄为 4.04 个月（范围 1.6-39 个月）。有 3 例患儿因术中技术失败和术后双 J 支架迁移需要行开放输尿管再植入术。26 例（29 个肾脏单位）患儿成功行 VUJ 腔内扩张，通过超声和 MAG-3-Lasix（呋塞米）研究进行随访，结果显示 20 例（23 个肾脏单位）患儿在最初 18 个月内输尿管积水和引流均有逐渐改善（69%）。在 2 例接受 3mm 球囊扩张的患儿中，进一步扩张后效果良好。队列研究（中位随访 47 个月）显示，所有在腔内球囊扩张后 18 个月时疗效良好的患儿均保持无症状状态，超声显示输尿管积水消退，肾图显示引流良好，而少数患儿仍存在持续性肾积水。
我们的研究表明，行 VUJ 高压球囊扩张治疗的 POM 患儿，如果在 18 个月时外观满意，则随着时间的推移，这些结果将保持稳定。
