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TH
CONGRESS OF THE ESPU
MATERIAL AND METHODS
Twenty four children with a mean age of 11.5 years were prospectively enrolled in this study.
Technique of simultaneous removal of the upper urinary tract stones on both sides consisted of
removal of the stone from the kidney or the ureter of the technically less complicated side followed
by the removal of the stone on the contralateral side. Stones were arranged in renal collecting
system in both side (n=8), and in ureters on both sides (n=10) and the remaining (n=6) on one side
in the kidney, another side in the ureter.
RESULTS
Mean stone size of both renal unit and ureter ranged from 8 to 22 (14.6 mm) and 5-12 (7.2 mm)
respectively. Mean operating time was 98 minutes. Mean hospital stay was 2.4 days. Stone free
rate was 83.3% after a single session. Complications included ureteric perforation and extravasa-
tion (n=2), postoperatively, moderate hematuria (n=4) and febrile UTI (n=2) requiring intravenous
antibiotics. Four patients (16.6%) needed auxiliary procedures for complete recovery of the residual
stones in the form of ESWL (n=3) and PCNL (n=1).
CONCLUSIONS
Bilateral simultaneous retrograde intrarenal surgery in children is safe and feasible with good stone
clearance and low morbidities. It eliminates the need for repeated anesthesia and psychological
stress associated with multiple interventions. However, this practice should be restricted to tertiary
referral centers with high stone volume.
11:33–11:36
S23-7 (PP)
HIGH PRESSURE BALLOON DILATATION FOR PRIMARY
OBSTRUCTIVE MEGAURETER: CAN WE IMPROVE
THE TECHNIQUE?
Ermelinda MELE, Simona GEROCARNI NAPPO, Michele INNOCENZI,
Giuseppe COLLURA, Paolo CAIONE and Nicola CAPOZZA
Bambino Gesu’ Children’s Hospital, Pediatric Urology, Dept of Surgery, Rome, ITALY
PURPOSE
Endoscopic high pressure balloon dilatation (EHPBD) is a recent minimally invasive option for the
treatment of primary obstructive megaureter (POM). In some patients however EHPBD is not fea-
sible nor successful. Aim is to assess whether modification of the technique can improve feasibility
of EHPBD.
MATERIAL AND METHODS
Since January 2009 EHPBD was offered unselectively to all infants and children with POM requir-
ing correction. Inclusion criteria were: ureter >15 mm with increasing dilatation,UTI, loss of split
renal function or obstruction at the vesico-ureteric junction at MAG3 renal scan. Since September
2014 two technical modifications were introduced: the use of an open-tip 3ch ureteric catheter for
retrograde pyelogram, and the use of 6 and 7 Fr balloon catheter for dilatation, which replaced the
3 or 4 Fr. Retrospectively, patients treated before September 2014 (group A: 20) were compared
with patients treated afterwards (group B: 23). Fisher’s exact test was used for statistic analysis.
RESULTS
44 patients underwent EHPBD, 29 M,29 left side, mean age 24 mths (median 12), all unilateral.
In group A the procedure was not feasible or unsuccessful in 6 (inability to negotiate the VUJ in
2, inadequated dilatation of the ureteric ring with the 4 Fr balloon catheter in 4), 30% failure rate.
In group B the VUJ was always negotiated and failure to dilate occurred in 1/23 case (8%). The
difference was significant (p =0.0377).