High pressure Balloon dilatation as a new method of treatment for obstructive uropathy

Sergey Nikolayevich Zorkin - Head of the Urology Department with Reproductive Medicine and Transplantation Groups of the FSAI "National Medical Research Center of Children's Health" of the Russian Federation Ministry of Health

S.N. Zorkin, V.I.Gubarev, S.A.Borisova, D.S. Shakhnovsky, V.Y.Salnikov, E.K. Zhamynchiev

Background

In the structure of urinary tract surgical pathology in children ureteropelvic junction obstruction (UPJ) has a significant place. The gold standard for UPJ obstruction is Hynes-Anderson technique. However, in modern urology there is a tendency to minimize procedure morbidity using modern equipment. Due to this tendecy it became possible to increase UPJ functional size using high-pressure balloon dilatation technique. In literature there are only a few descriptions of utilizing of this treatment method in children.

Goal

To substantiate the possibility of surgical treatment of UPJ obstruction in children using high-pressure balloon dilatation

Materials and methods

This paper is based on data analysis of treatment of 254 children aged from 2 months to 7 years, who underwent surgery for congenital hydronephrosis from 2006 to 2018. Study includes children with II (54.7%) and III (45.3%) hydronephrosis stage. All patients were divided into 3 groups depending on treatment technique. Group I consisted of 83 children treated with balloon dilatation; patients in II group (79 patients) underwent ureteral stenting and patients of the III group  (92 patients) underwent UPJ pyeloplasty. Criteria of efficiency evaluating included anteroposterior pelvic size changes, fractional kidney function dynamics and washout rate index from renal pelvis. All patients in the study underwent a control examination with a result assessment in 6 months after treatment

Results

We distinguished mild, moderate, and severe grades of urodynamic disturbances, depending on washout rate index decrease. Data analysis revealed statistically significant differences in surgical treatment results, depending on severity of obstruction in groups of patients with balloon dilation and stenting (Group I and II). In case of mild urodynamic disturbances, balloon dilatation was effective in 100% of cases. In children with mild disturbances its effectiveness was 86.7%. In patients with severe obstruction of UPJ, it was 23.8%. Among children in stenting group with mild degree of urodynamic disorders efficiency was 100% and with a moderate degree - 76%. After Hynes pyeloplasty, we did not reveal any urodynamic disturbances. The highest percentage of successful treatment was obtained by using Hynes pyeloplasty. It was 97.8%. The second-best method was high pressure balloon dilatation: 73.5%. The ureteral stenting technique was the least effective: 62.0%

Conclusions

High pressure balloon dilatation technique is highly effective in the treatment of UPJ obstruction. The indications for its use are mild and moderate severity of urodynamic disturbances in UPJ. Contraindication for using of this technique is a severe degree of urodynamic disturbances. The effectiveness of balloon dilatation makes it a preferable technique for treating of mild and moderate UPJ obstruction because of its low invasiveness.