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Endoscopic balloon dilation of primary obstructive megaureter: is fluoroscopic guidance necessary?

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Abstract

Objective

To compare the long-term effectiveness, complications, and outcomes of primary obstructive megaureter (POM) treated by endoscopic balloon dilation under fluoroscopic guidance versus not using radioscopy during the procedure.

Patients and methods

A comparative study between POM cases treated at our institution by endoscopic balloon dilation (EBD) under fluoroscopic guidance (FG) (n = 43) vs no fluoroscopic guidance (NFG) (n = 48) between the years 2004 and 2018 was conducted. The procedure in FG consisted of performing a retrograde pyelography before dilation. Then, a guidewire is introduced to the renal pelvis, and the dilation of the vesicoureteral junction is performed using high-pressure balloon catheters under fluoroscopic vision. Finally, a double-J stent is placed between the renal pelvis and bladder. The procedure in NFG was performed exclusively under cystoscopic vision without radiological exposure. Complications, outcomes, and success rates were analyzed using Spearman’s correlation test. Mean follow-up was 12.5 ± 2.2 years in FG and 6.4 ± 1.3 years in NFG.

Results

MAG-3 showed significant differences in renal drainage before and after endoscopic treatment in both groups (p < 0.001 T-test). Statistical analysis did not reveal differences between groups in initial technical failure (r: − 0.035, p = 0.74), early postoperative complications (r: − 0.029, p = 0.79), secondary VUR (r: 0.033, p = 0.76), re-stenosis (r: 0.022, p = 0.84), long-term ureteral reimplantation (r: 0.065, p = 0.55), and final outcome (r: − 0.054, p = 0.61). The endoscopic approach of POM had a long-term success rate of 86.5% in FG VS 89.6% in NFG.

Conclusions

Endoscopic balloon dilation of POM can be done with no radiation exposure with similar results, effectiveness, and outcomes.

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Funding

No public or private funding was received.

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Authors and Affiliations

  1. Pediatric Urology Division, Department of Pediatric Surgery, Hospital Universitario Gregorio Marañón, Madrid, Spain

    Rubén Ortiz, Laura Burgos, Beatriz Fernández-Bautista, Alberto Parente, Javier Ordóñez & Jose María Angulo

Authors
  1. Rubén Ortiz
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  2. Laura Burgos
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  3. Beatriz Fernández-Bautista
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  4. Alberto Parente
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  5. Javier Ordóñez
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  6. Jose María Angulo
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Contributions

RO was involved in project development, collected the data, and wrote the manuscript. LB analyzed the data and wrote the manuscript. BF-B collected the data. AP was involved in project development. JO analyzed the data. JMA was involved in project development and wrote the manuscript.

Corresponding author

Correspondence to Rubén Ortiz.

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Conflict of interest

All authors declare that they did not have conflicts of interest in the elaboration of this study.

Informed consent

This study was carried out by the recommendations of “Paediatric patient’s management standards”, from the Deontological Committee of University Hospital Gregorio Marañón. All subjects gave written informed consent following the Declaration of Helsinki. The protocol was approved by the Deontological Committee.

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Ortiz, R., Burgos, L., Fernández-Bautista, B. et al. Endoscopic balloon dilation of primary obstructive megaureter: is fluoroscopic guidance necessary?. World J Urol 41, 2861–2867 (2023). https://doi.org/10.1007/s00345-023-04572-z

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  • DOI: https://doi.org/10.1007/s00345-023-04572-z

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