Kassite Ibtissam, Renaux Petel Mariette, Chaussy Yann, Eyssartier Emilie, Alzahrani Khalid, Sczwarc Caroline, Villemagne Thierry, Lardy Hubert, Braik Karim, Binet Aurélien
Department of Pediatric Surgery, University Teaching Hospital of Tours, Gatien de Clocheville Hospital, Tours, France.
Department of Pediatric Surgery, University Teaching Hospital of Rouen, Charles Nicolle Hospital, Rouen, France.
Front Pediatr. 2018 Oct 31;6:329. doi: 10.3389/fped.2018.00329. eCollection 2018.
We described the initial experience of four 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 multicenter study to assess its effectiveness in long-term. We reviewed the medical records of all children who underwent HPBD for POM that require surgical treatment from May 2012 to December 2017 in four 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. Forty-two 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. 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.
我们描述了四个转诊中心通过输尿管膀胱连接部高压球囊扩张术（HPBD）并置入双J支架治疗儿童原发性梗阻性巨输尿管（POM）的初步经验。我们开展了一项回顾性多中心研究以评估其长期有效性。我们回顾了2012年5月至2017年12月期间在四个不同机构因POM需手术治疗而接受HPBD的所有儿童的病历。主要测量结果是输尿管肾盂积水（UHN）及其术后改善程度。次要结果是术后并发症和术前症状的缓解情况。33名儿童的42条输尿管接受了POM的HPBD治疗，中位年龄为14.7个月（范围：3个月至15岁）。一次内镜治疗后86%的输尿管肾盂积水得到改善。3例需要进行第二次HPBD。4例患者在内镜治疗后因输尿管肾盂积水恶化而需要手术治疗。术后并发症发生率为50%（21条输尿管）。在13例（61%）中，并发症与双J支架有关。中位随访时间为24个月（2个月至5年），所有患者均无症状。我们报告了第一项多中心研究以及接受HPBD治疗的最大系列儿童病例，总体成功率为92%。内镜治疗可以成为POM的确定性治疗方法，因为在90%的病例中避免了再植术。并发症主要归因于双J支架。
