Pediatric Urology Unit, Department of Pediatric Surgery, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig de Sant Joan de Déu, 2. , 08950, Barcelona, Spain.
World J Urol. 2024 Aug 1;42(1):463. doi: 10.1007/s00345-024-05181-0.
High-pressure balloon dilatation (HPBD) of the ureterovesical junction with double-J stenting is a minimally invasive alternative to ureteral reimplantation or cutaneous ureterostomy for first-line surgical treatment of primary obstructive megaureter (POM). The aim of our study was to identify the risk factors associated with the need for secondary procedures due to HPBD failure.
Prospective data were collected from patients who underwent HPBD for POM between 2007 and 2021 at a single institution. The collected data included patient demographics, diagnostic modalities, surgical details, results, and follow-up. Multivariate logistic regression analysis was performed.
Fifty-five ureters underwent HPBD for POM in 50 children, with a median age of 6.4 months (IQR: 4.5-13.8). Nineteen patients (37.25%) underwent secondary ureteric reimplantation, with a median of 9.8 months after primary HBPD (95% CI 6.2-9.9). The median follow-up was 29.4 months (IQR: 17.4-71). Independent risk factors for redo-surgery in a multivariate logistic regression model were: progressive ureterohydronephrosis (OR = 7.8; 95% CI 0.77-78.6) and early removal of the double-J stent. A risk reduction of 7% (95% CI 2.2%-11.4%) was observed per extra-day of catheter maintenance. The optimal cut-off point is 55 days, ROC curve area: 0.77 (95% CI 0.62-0.92). Gender, distal ureteral diameter, pelvis diameter, dilatation balloon diameter and preoperative differential renal function did not affect the need for reimplantation.
The use of a double-J stent for at least 55 days seems to avoid the need for a secondary procedure. Therefore, we recommend removing the double-J catheter at least 2 months after the HBPD.
对于原发性巨输尿管症（POM）的一线手术治疗，高压球囊扩张（HPBD）联合双 J 支架置入术治疗输尿管-膀胱连接部是替代输尿管再植术或皮输尿管造口术的一种微创选择。本研究的目的是确定与 HPBD 失败相关的需要进行二次手术的危险因素。
本研究前瞻性地收集了 2007 年至 2021 年期间在一家单机构接受 HPBD 治疗 POM 的患者资料。收集的数据包括患者人口统计学、诊断方式、手术细节、结果和随访。进行多变量逻辑回归分析。
50 例儿童的 55 侧输尿管接受了 HPBD 治疗 POM，中位年龄为 6.4 个月（IQR：4.5-13.8）。19 例（37.25%）患者接受了二次输尿管再植术，首次 HPBD 后中位时间为 9.8 个月（95%CI 6.2-9.9）。中位随访时间为 29.4 个月（IQR：17.4-71）。多变量逻辑回归模型中的独立再手术危险因素包括：进行性输尿管积水（OR=7.8；95%CI 0.77-78.6）和双 J 支架的早期移除。留置导尿管每额外 1 天，再手术风险降低 7%（95%CI 2.2%-11.4%）。最佳截断点为 55 天，ROC 曲线下面积为 0.77（95%CI 0.62-0.92）。性别、远端输尿管直径、肾盂直径、扩张球囊直径和术前分肾功能均不影响再植术的需要。
使用双 J 支架至少 55 天似乎可以避免需要进行二次手术。因此，我们建议在 HPBD 后至少 2 个月取出双 J 导管。
