Management of Ureteropelvic Junction Obstruction With High-pressure Balloon Dilatation: Long-term Outcome in 50 Children Under 18 Months of Age EDITORIAL COMMENT

OBJECTIVE To analyze the usefulness of dilatation in the treatment of ureteropelvic junction obstruction (UPJ) in children <18 months of age, including newborns and infants. METHODS Patients (n = 50; <18 months of age) were diagnosed using abdominal ultrasound, cystogram, and diuretic renography. Treatment was with endourologic retrograde balloon dilatation under fluoroscopic guidance. The balloons were, in all cases, semicompliant with a profile of 5 mm, 6 mm, or 7 mm. Follow-up was for 42.9 +/- 23.2 months (mean +/- SD). Double-J stents were inserted postdilatation, the caliber and length depending on the patient's body weight. RESULTS Intervention duration was 22 +/- 19 minutes. Dilatation was not possible in 5 patients, and pyeloplasty was the alternative treatment. Hospital stay was 24 hours in 44 patients. Analgesic needs were met exclusively by nonsteroidal anti-inflammatory drugs. The double-J stent was withdrawn using cystoscopy and the UPJ was calibrated. Residual stenosis was found in 7 patients. A second dilatation was required in 3 patients 6-18 months after surgery because of the lack of improvement of hydronephrosis. During follow-up, resolution of the hydronephrosis was observed in 45 cases (anterior-posterior diameter of the renal pelvis 7 +/- 5 mm). The diuretic renography improved in 45 infants; the shape of the curve being normal in 44 cases and semi-obstructive in 1. CONCLUSION We believe that high-pressure balloon dilatation could be a valid and safe option in the minimally invasive treatment of UPJ obstruction in infants. The outcome is acceptable with a low complication rate. (C) 2013 Elsevier Inc.