The use of balloon cardiac catheters for vesicoureteral segment obstruction in pediatric urology
Abstract
Aim. To establish the possibility of using balloon
catheters intended to cardio-thoracic surgery for the treatment of
vesicoureteral junction obstruction with high-pressure balloon dilatation
(HPBD) in children.
Material and methods. Between 2019 and 2021 a total of 51 children with
primary obstructive megaureter underwent HPBD. 27 boys and 24 girls were
included in the study. The mean age by the time of surgery in both groups was
19 months. The follow-up period for all patients was 1 year. According to data
analysis patients were divided in two groups by age: from 1 month to 1 year and
from 1 year to 4 years.
Results. In our study we found the following treatment
effectiveness criteria: the length of the stenotic area of the ureter, the
diameter of the stenosis and area of stenosis. The area of stenosis was
determined during the HPBD procedure based on targeted retrograde pyelography.
The overall effectiveness of primary obstructive megaureter treatment using HPBD
was 84%. This technique has shown a 93% efficiency rate in the first age group
(from 1 month to 1 year) and 75% – in the second (from 1 year to 4 years). We
found that all positive results were obtained when the length of the stenotic
area was lower than 1.8 mm, diameter of the stenosis was more than 0.6 mm, and
the stenosis area was less than 96.6%. HPBD failed in cases of 99% area of
stenosis and more.
Conclusion. The use of balloon catheters is applicable as a
transluminal method for the treatment of obstructive megaureter in children of
a younger age group. This technique is more effective combined with
high-frequency targeted pyelography for assessment of stenosis characteristics.
It allows to determine both indications for HPBD use and increases its effectiveness.
Keywords:Balloon catheter; ureter obstruction; balloon dilatation; megaureter
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Zorkin S.N., Galuzinskaya A.T., Petrov E.I., Filinov
I.V. The use of balloon cardiac catheters for vesicoureteral segment
obstruction in pediatric urology. Clinical and Experimental Surgery. Petrovsky
Journal. 2022; 10 (3): 108–13. DOI: https://doi.org/10.33029/2308-1198-2022-10-3-108-113
(in Russian)
References
1. Khatsevich T.N., Mikhaylov I.O. Endoscopes: A textbook. Novosibirsk: SGGA, 2002: 2–11. (in Russian)
2. Fontenot C., O’Leary J.P. Dr. Werner Forssman’s self-experimentation. Am Surg. 1996; 62 (6): 514–5.
3. Casey R.G., Thornhill J.A. Joaquin Maria Albarran Y Dominguez: microbiologist, histologist, and urologist – a lifetime from orphan in Cuba to Nobel nominee. Int J Urol. 2006; 13: 1159–61.
4. Stehr M., Schäfer F.-M. Primary obstructive megaureter: a domain of conservative treatment. Aktuelle Urol. 2020; 51 (2): 127–31. DOI: https://doi.org/10.1055/a-1010-3697 Epub 2019 Dec 5.
5. Khan F., Ahmed K., Lee N., Challacombe B., Khan M.S., Dasgupta P. Management of ureteropelvic junction obstruction in adults. Nat Rev Urol. 2014; 11: 629–38.
6. Osther P.J., Geertsen U., Nielsen H.V. Ureteropelvic junction obstruction and ureteral strictures treated by simple high-pressure balloon dilation. J Endourol. 1998; 12: 429–31.
7. Torino G., Collura G., Mele E., Garganese M.C., Capozza N. Severe primary obstructive megaureter in the first year of life: preliminary experience with endoscopic balloon dilation. J Endourol. 2012; 26: 325–9. URL: https://doi.org/10.1089/end.2011.0399 Epub 2011 Dec 7.
8. Angerri O., Caffaratti J., Garat J.M, Villavicencio H. Primary obstructive megaureter: initial experience with endoscopic dilatation. J Endourol. 2007; 21: 999–1004.
9. Angulo J.M., Arteaga R., Rodriguez Alarcon J., Calvo M.J. Role of retrograde endoscopic dilatation with balloon and derivation using double pig-tail catheter as an initial treatment for vesico-ureteral junction stenosis in children. Cir Pediatr. 1998; 11 (1): 15–8.
10. Christman M.S., Kasturi S., Lambert S.M., Kovell R.C., Casale P. Endoscopic management and the role of double stenting for primary obstructive megaureters. J Urol. 2012; 187: 1018–22.
11. Garcıa-Aparicio L., Rodo J., Krauel L., Palazon P., Martin O., Ribo J.M. High pressure balloon dilation of the ureterovesical junction-first line approach to treat primary obstructive megaureter? J Urol. 2012; 187: 1834–8.
12. Shuang Li, Fengping Tang, Shixi Dai, Huixia Zhou, Longjie Gu. Balloon dilatation for lower urethral obstruction in children. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006; 20 (3): 238–40.
13. Sal’nikov V.Yu., Gubarev V.I., Zorkin S.N., Filinov I.V., Petrov E.I. High-pressure endoscopic balloon dilatation as the method of primary obstructive megaureter treatment in children. Pediatriya. Zhurnal imeni G.N. Speranskogo [Pediatrics. Journal named after G.N. Speransky]. 2016; 95 (5): 48–52. (in Rus- sian)
14. Sal’nikov V.Yu., Zorkin S.N., Gubarev V.I., Filinov I.V., Petrov E.I., Akopyan A.I., et al. Modern aspects of low-invasive treatment of primary obstructive megaloureter in children. Detskaya khirurgiya [Pediatric Surgery]. 2016; 20 (3): 155–9. DOI: https://doi.org/10.18821/1560-9510-2016-20-3-155-159 (in Russian)
15. Gubarev V.I., Zorkin S.N., Sal’nikov V.Yu., Filinov I.V., Petrov E.I., Shakhnovsky D.S. Possibilities of high pressure balloon dilatation in treatment of ureteropelvic junction obstruction in children. Pediatriya. Zhurnal imeni G.N. Speranskogo [Pediatrics. Journal named after G.N. Speransky]. 2018; 97 (5): 159–63. (in Russian)
16. Osipov I.B., Lebedev D.A., Komissarov M.I., Sarychev S.A., Osipov A.I. Ballooning of the ureterovesical segment in obstructive megaureter in children. Rossiyskiy vestnik detskoy khirurgii, anesteziologii i reanimatilogii [Russian Bulletin of Pediatric Surgery, Anesthesiology and Resuscitation]. 2015; (S): 110. (in Russian)
17. Chiarenza S.F., Bleve C., Zolpi E., Battaglino F., Fasoli L., Bucci V. Endoscopic balloon dilatation of primary obstructive megaureter: method standardization and predictive prognostic factors. Pediatr Med Chir. 2019; 41 (2).
18. Bujons A., Saldana L., Caffaratti J., Garat J.M., Angerri L.O., Villavicencio H. Can endoscopic balloon dilation for primary obstructive megaureter be effective in a long-term follow-up. J Pediatr Urol. 2015; 11: 37.e1–6.
19. Kassite I., Petel M.R., Chaussy Y., Eyssartier E., Alzah- rani K., Sczwarc C., et al. High pressure balloon dilatation of primary obstructive megaureter in children: a multicenter study. Front Pediatr. 2018; 6: 329.
20. Destro F., Selvaggio G., Marinoni F., Pansini A., Riccipetitoni G. High-pressure balloon dilatation in children: our results in 30 patients with POM and the implications of the cystoscopic evaluation. Pediatr Med Chir. 2020; 42 (1).
21. Galuzinskaya A.T., Zorkin S.N. Efficacy of high-pressure balloon dilatation in the treatment of children with primary obstructive megaureter. Rossiyskiy pediatricheskiy zhurnal [Russian Journal of Pediatrics]. 2020; 23 (6): 419. (in Russian)
22. Ning Xu, Shao-Hao Chen, Xue-Yi Xue, Qing-Shui Zheng, Yong Wei, Tao Jiang, et al. Comparison of retrograde balloon dilatation and laparoscopic pyeloplasty for treatment of ureteropelvic junction obstruction: results of a 2-year follow-up. PLoS One. 2016; 11 (3): e0152463. DOI: https://doi.org/10.1371/journal.pone.0152463. Epub 2016 Mar 28.
23. Ko Y.H., Choi J.Y., Song P.H., Moon K.H., Jung H.C. Retrograde pyelography before radical nephroureterectomy for upper urinary tract urothelial carcinoma aggravates intravesical tumor recurrence. Eur Urol Suppl. 2019; 18 (1): e2176–7.