Ordóñez Javier, Ortiz Rubén, Parente Alberto, Burgos Laura, Fernández-Bautista Beatriz, Pérez-Egido Laura, Angulo José María
Pediatric Urology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Reina Sofía University Hospital, Córdoba, Spain.
Front Pediatr. 2022 Apr 25;10:863625. doi: 10.3389/fped.2022.863625. eCollection 2022.
To analyze the effectiveness, complications and long-term outcome of the patients with ureteropelvic junction obstruction (UPJO) treated by endoscopic retrograde balloon dilatation (ERBD) in the largest series reported.
Between years 2004 and 2018, 112 patients with primary unilateral UPJO were treated by ERBD. Endoscopic treatment consisted on a retrograde balloon dilatation of the ureteropelvic junction (UPJ), through cystoscopy and under fluoroscopic guidance, using high-pressure balloon catheters. In case of persistence in the balloon notch, a Cutting Balloon™ catheter was used. Double-J stent was placed after dilatation.
Mean age at surgery was 13.1 ± 21.3 months, 92 cases being younger than 18 months. Mean operative time was 24.4 ± 10.3 min; hospital stay was 1 day in 82% of patients. No intraoperative complications occurred. UPJ was calibrated at time of stent removal with cystoscopy 39.1 ± 13.7 days after dilatation. ERBD was not possible in 11 cases. An additional procedure was needed in 24 cases: second ERBD ( = 11, seven during the stent withdrawal), a third dilatation ( = 3) due to persistent hydronephrosis, and percutaneous endopyelotomy ( = 3) or open pyeloplasty ( = 7) in cases of technical failure. Significant improvement in postoperative ultrasound measures were observed ( < 0.05, T-test). Long-term success rate was 76.8% after one dilatation, and 86.6% in those who required up to 2 dilatations. Mean follow-up was 66.7 ± 37.5 months.
ERBD is a feasible and safe option for the minimally invasive treatment of UPJ obstruction in infants. Long-term outcome is acceptable with a very low complication rate.
在已报道的最大规模系列研究中，分析经内镜逆行球囊扩张术（ERBD）治疗肾盂输尿管连接部梗阻（UPJO）患者的有效性、并发症及长期疗效。
2004年至2018年期间，112例原发性单侧UPJO患者接受了ERBD治疗。内镜治疗包括在膀胱镜检查及透视引导下，使用高压球囊导管对肾盂输尿管连接部（UPJ）进行逆行球囊扩张。若球囊切迹持续存在，则使用切割球囊导管。扩张后放置双J支架。
手术时的平均年龄为13.1±21.3个月，92例患者年龄小于18个月。平均手术时间为24.4±10.3分钟；82%的患者住院时间为1天。未发生术中并发症。扩张后39.1±13.7天，通过膀胱镜检查在取出支架时对UPJ进行校准。11例患者无法进行ERBD。24例患者需要额外的手术：第二次ERBD（n = 11，其中7例在取出支架期间），因肾积水持续存在进行第三次扩张（n = 3），以及在技术失败的情况下进行经皮肾造瘘术（n = 3）或开放性肾盂成形术（n = 7）。术后超声测量结果有显著改善（t检验，P < 0.05）。一次扩张后的长期成功率为76.8%，需要进行多达2次扩张的患者长期成功率为86.6%。平均随访时间为66.7±37.5个月。
ERBD是婴儿UPJ梗阻微创治疗的一种可行且安全的选择。长期疗效可接受，并发症发生率极低。
