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Antegrade Ballon Dilatation of Pelvi-Ureteric Junction Obstruction in Infants and Children - Abstract

Hilal Matta, Aymen Saleh, Ahmed H. Al-Salem

 

Abstract

Background: Pelviureteric junction (PUJ) obstruction is the commonest cause of urinary tract obstruction in children. The majority of prenatally diagnosed PUJ resolve spontaneously but 20-25% will worsen and require intervention. The treatment options include: open pyeloplasty, laparoscopic and robot assisted pyeloplasty and endoluminal balloon dilatation. This is a report of our experience with antegrade balloon dilatation for PUJ obstruction in children. The aim of this study was to evaluate the effectiveness of balloon dilatation with double J stenting in the management of infants and children with PUJ obstruction.

Patients and methods: A total of 24 children (14 males and 10 females) with a mean age of 4.2 months (1.5 months-13 years) who had antegrade balloon dilatation for PUJ obstruction were reviewed. All had increasing dilatation of the renal pelvis on ultrasound and obstructive curve on MAG3 isotope scan with minimal or no response to diuretics.

Results: There were 3 technical failures. All three had nephrostomy followed by pyeloplasty, 21 had successful dilatation and 20 of them were discharged home the next day. One developed fever. All had a double J stent which was removed 6-8 weeks later. On follow-up (mean 26 months), 16 had excellent outcome while in 5, there was recurrence of hydronephrosis. Four of them underwent pyeoplasty and 1 was lost for follow-up. The overall success rate was 66.7% and if we exclude the technical failures and the one lost for follow-up, it is 74%.

Conclusion: Balloon dilatation of PUJ obstruction in infants and children is technically feasible, safe and viable alternative to open or laparoscopic pyeloplasty. This is especially true in infants where surgery is technically difficult and in experienced hands its efficacy is comparable to open or laparoscopic pyeloplasty.

Keywords: pelvi-ureteric junction obstruction, balloon dilatation, double J-stent

 

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