Ortiz Ruben, Parente Alberto, Perez-Egido Laura, Burgos Laura, Angulo José Maria
Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Front Pediatr. 2018 Oct 5;6:275. doi: 10.3389/fped.2018.00275. eCollection 2018.
To assess long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation (EBD) in the largest series reported. Hundred POM in 92 consecutive patients were treated by EBD between years 2004 and 2016. A total of 79 POM (73 patients) with more than 18 months of follow-up after treatment have been analyzed. EBD of the vesicoureteral junction was performed with semicompliant high-pressure balloon catheters (2.7FG) with minimum balloon diameter of 5 mm, followed by temporary Double-J stent placement. Follow-up protocol included periodical clinical reviews, US and MAG-3 renogram scans. Median age at surgery was 4 months (15 days-3.6 years), with median operating time of 20 min (10-60) and hospital stay of 1 day (1-7). Initial renal function was preserved in all patients with significant improvement in renal drainage on the MAG-3 diuretic renogram after endoscopic treatment ( < 0.001 -test). Significant post-operative differences were observed in hydronephrosis grade and ureteral diameter that were maintained in the long-term ( < 0.001 -test). Endoscopic approach of POM had a long-term success rate of 87.3%, with a mean follow-up of 6.4 ± 3.8 years. Secondary VUR was found in 17 cases (21.5%), being successfully treated by endoscopic subureteral injection in 13 (76.4%). Nine cases developed long-term re-stenosis (12.2%) that were successfully treated with a new EBD in 8. Endoscopic management of POM failed in 10 cases (12.7%) that required ureteral reimplantation. Five were early failures (4 intraoperative technical problems and 1 double-J stent migration with severe re-stenosis), and 5 long-term (4 persistent VUR and 1 re-stenosis recurrence). EBD has shown to be an effective treatment of POM with few complications and good outcomes at long-term follow up. Main complication was secondary VUR that could also be treated endoscopically with a high success rate. In our opinion, EBD may be considered first-line treatment in POM.
在已报道的最大规模系列研究中，评估经内镜球囊扩张术（EBD）治疗原发性梗阻性巨输尿管（POM）的长期疗效、并发症及预后。2004年至2016年间，对92例连续患者的100例POM进行了EBD治疗。共分析了79例POM（73例患者），其治疗后随访时间超过18个月。采用最小球囊直径为5 mm的半顺应性高压球囊导管（2.7FG）对膀胱输尿管连接部进行EBD，随后临时置入双J支架。随访方案包括定期临床复查、超声和MAG-3肾图扫描。手术时的中位年龄为4个月（15天至3.6岁），中位手术时间为20分钟（10至60分钟），住院时间为1天（1至7天）。所有患者的初始肾功能均得以保留，内镜治疗后MAG-3利尿肾图显示肾引流有显著改善（t检验，P<0.001）。观察到肾盂积水分级和输尿管直径在术后有显著差异，且长期保持（t检验，P<0.001）。POM的内镜治疗长期成功率为87.3%，平均随访时间为6.4±3.8年。17例（21.5%）发现继发性膀胱输尿管反流（VUR），其中13例（76.4%）经内镜输尿管下注射成功治疗。9例出现长期再狭窄（12.2%），其中8例经再次EBD成功治疗。10例（12.7%）POM的内镜治疗失败，需要进行输尿管再植术。5例为早期失败（4例术中技术问题和1例双J支架移位伴严重再狭窄），5例为长期失败（4例持续性VUR和1例再狭窄复发）。EBD已被证明是治疗POM的有效方法，并发症少，长期随访效果良好。主要并发症是继发性VUR，也可通过内镜治疗获得较高成功率。我们认为，EBD可考虑作为POM的一线治疗方法。
