Balloon Dilatation of Iatrogenic Ureteral Strictures after Upper Urinary Tract Reconstruction

Abstract

Purpose: Open pyeloplasty is the gold standard treatment of uretero-pelvic junction (UPJ) stenosis. Although failure after open pyeloplasty or uretero-neosistosmy is not common, percutaneous or endoscopic interventions must be necessary in some cases. We present treatment of 6 pediatric patients by balloon dilatation after failed surgery.

Material and Methods: Between 2008 and 2013 6 children were treated. Five patients had undergone open pyeloplasty for UP stenosis and, one has uretero-vesical anastomosis stricture after ureteroneosistostomy. Percutaneous antegrade balloon dilatation and double J stent placement were performed in three of six patients. In the other three patients retrograde endoscopic balloon dilatation and double J stent placement were performed.

Results: Primary technical success was %50 and %100 for antegrade and retrograde approach respectively. Antegrade approach has failed in 3 patients (%50) and, retrograde approach and treatment were successful in all of these patients. Secondary and tertiary balloon dilatations were done through antegrade approach in 3 patients. Mean duration of double J stent was 114 days. As of today, five patients are followed smoothly. One patient who has UP stenosis underwent secondary open surgery.

Conclusion: Balloon dilatation can be used safely in both antegrade and retrograde approaches because of lower profile of balloon catheters, so it could be considered as a first line treatment option after failed surgical treatment of upper urinary tract stenosis in children.