Tratamiento endourológico de la estenosis pieloureteral en la edad pediátrica: nuestra experiencia

ENDOUROLOGICAL TREATMENT OF PELVIURETERIC JUNCTION OBSTRUCTION IN PAEDIATRIC PATIENTS: OUR EXPERIENCE Endourological treatment of pelviureteric junction obstruction in paediatric patients: our experience. Introduction. Pelviureteric junction (PUJ) obstruction is the most common cause of hydronephrosis in the infancy. The gold standard of treatment is open pyeloplasty, but there is an ever greater tendency towards minimally invasive procedures. We pre- sent our serie of paediatric patients with endourologically treated PUJ obstruction, together with a review of the literature. Material and methods. Retrospective, descriptive study of the children diagnosed of PUJ obstruction who were treated by an endourological technique in our centre between January 1988 and January 2005. We gathered data on 3 periods of time:1st. Presurgical: age, sex, previous treatment, ultrasound (USS) and nuclear medicine (MAG-3) studies; 2 nd . Surgical: type of proce- dure; 3rd. Surgical: recurrence or not and its treatment, and the current state of the patient. Results. Seven children, with an age range of 13 months to 14 years, underwent operation using an endourological techni- que. The treatment was secondary in five of these patients, after open pyeloplasty, and was primary in 2 cases. The preoperati- ve USS showed grade III dilatation in 3 and grade IV dilatation in 4, and the MAG-3 study showed type II curves in 6 and a type IIIb curve in 1. Three percutaneous endopyelotomies were performed and, by the retrograde approach, 3 balloon dilatations and one Acucise. With a mean follow-up of 37 months, 2 cases of recurrence (both in patients receiving secondary treatment) have been observed, one in whom a retrograde technique (balloon dilatation) was used and the other in a patient treated by an ante- grade technique. The remaining five patients are asymptomatic and show no evidence of recurrence (71% of the patients). Conclusion. The endourological treatment of PUJ obstruction in paediatric patients is possible but must be individualised in each case. Larger, prospective studies need to be performed in order to reach conclusions.