This study examines a decade-long experience with endoscopic balloon dilation (EBD) as a minimally invasive treatment approach for primary obstructive megaureter (POM), a condition where some ureters remain dilated due to obstruction, leading to symptoms or decreased renal function. While many cases of megaureter resolve naturally, some require intervention, especially when differential renal function (DRF) drops below 40% or symptoms develop. In this study, children diagnosed with POM were advised to try EBD before considering more invasive surgeries like reimplantation or ureterostomy. During the procedure, a 9.5Fr cystoscope and stent pusher were used to insert a 14-inch guidewire, allowing the placement of a 4/25 mm coronary dilation balloon inflated to 15 ATM for 5 minutes, followed by the insertion of a 4.7Fr DJ stent for 6 weeks. When needed, a second dilation was performed.
Among the 28 patients (23 male, 5 female) included, with a median age of 9 months, EBD was successful in 93.5% of cases. A follow-up of 41 months revealed improvements in 96% of the treated ureters. A second dilation was required in 8 cases, and two cases, involving either a narrow distal ureter or a stenotic ring, needed more invasive surgeries. Minor complications were noted, with 10% of patients developing a urinary tract infection and 6% requiring ureteroscopic retrieval of the DJ stent due to complications like calcification.
The findings suggest EBD is an effective, minimally invasive first-line treatment for POM in symptomatic children or those with declining DRF. EBD not only provides therapeutic benefits but also diagnostic insights into the length and nature of the obstruction, although longer stenotic segments tend to be less responsive to treatment.
