Enes DUMAN, Erkan YILDIRIM, İshak AKILLIOĞLU, Selçuk YÜCESAN

Üst Üriner Trakt Rekonstrüksiyonu Sonrası Oluşan İyatrojenik Üreteral Darlıkların Balon Dilatasyonu

Amaç: Üreteropelvik bileşke darlıklarının tedavisinde açık pyeloplasti altın standarttır. Üretero-neosistostomi ya da açık pyeloplasti sonrası başarısızlık nadir olmasına rağmen bazı vakalarda perkütan ya da endoskopik müdahaleler gerekli olabilir. Biz, 6 pediatrik hastanın başarısız acık cerrahi sonrası balon dilatasyonu ile tedavisini sunuyoruz. Materyal ve Metod: 2008 – 2013 yılları arasında 6 çocuk hasta tedavi edildi. Beş hastada üreteropelvik darlık nedeniyle açık pyeloplasti sonrası, bir hastada ise üreteroneosistostomi sonrası gelişen üretero-vezikal anastomoz striktürü tespit edildi. Altı hastanın üç tanesine perkütan antegrad balon dilatasyonu uygulandı ve “Double J” stent yerleştirildi. Diğer üç hastaya retrograd endoskopik balon dilatasyon yapıldı ve “Double J” stent yerleştirildi. Bulgular: Primer teknik başarı antegrad ve retrograd yaklaşım için sırası ile % 50 ve % 100 idi. Antegrad yaklaşım 3 hastada (%50) başarısız oldu , retrograd yaklaşım ve tedavi tüm hastalarda başarılı oldu. Sekonder ve tersiyer balon dilatasyonlar üç hastada antegrad yaklaşımla yapıldı. “Double J” stentin ortalama kalma süresi 114 gün idi. Bugüne dek beş hastanın izlemi sorunsuz olarak devam etti. UP darlığı olan bir hasta sekonder açık cerrahiye gitti. Araştırma Makalesi / Research Article 311 Duman et al. Cukurova Medical Journal Sonuç: Balon dilatasyon, balon kateterlerin yumuşak yapıları nedeni ile hem antegrad hem de retrograd yaklaşımlarda güvenle kullanılabilir. Bu nedenle de, çocuklardaki cerrahi olarak başarısız olmuş üst üriner trakt stenozlarının tedavisinde ilk seçenek olarak düşünülebilir

Anahtar Kelimeler:

Üreteropelvik bileşke darlıkları, balon dilatasyon, perkütan , pyeloplasti

Balloon Dilatation of Iatrogenic Ureteral Strictures after Upper Urinary Tract Reconstruction

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.

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Flaschner SC, King LR. Ureteropelvic junction. In: Kelalis PP, King LR, Belman AB editors. Clinical Pediatric Urology.Philadelphia, PA, Saunders, 1992.
Tan HL, Najmaldin A, Webb DR. Endopyelotomy for pelviureteric junction obstruction in children. Eur Urol. 1993;24:84–8.
Tan HI. Laparoscopic Anderson-Hynes dismembered pyeloplasty in children. J Urol. 1999;162:1045–8.
Slama MRB, Salomon L, Hoznek A, et al. Extraperitoneal laparoscopic repair of ureteropelvic junction obstruction. Initial experience in 15 cases. Urology. 2000;56:45–8.
Park JS, Kim WS, Hong B, Park T, Park HK. Long- term outcome of secondary endopyelotomy after failed primary intervention for ureteropelvic junction obstruction. International Journal of Urology. 2008;15:490–4
Kadir S, White RI Jr, Engel R. Balloon dilatation of ureteropelvic junction obstruction. Radiology. 1982;143:263–64.
Tan BJ, Smith AD. Ureteropelvic junction obstruction repair: when, how, what? Curr Opin Urol. 2004;14:55–9.
Veenboer PW, Chrzan R, Dik P, Klijn AJ, de Jong TP. Secondary endoscopic pyelotomy in children with failed pyeloplasty. Urology. 2011;77:1450–4.
Mackenzie RK, Youngson GG, Hussey JK, Mahomed AA. Is there a role for balloon dilatation of pelvi- ureteric obstruction in children? J Pediatr Surg. 2002;37:893–6.
Parente A, Angulo JM, Romero RM, Rivas S, Burgos L, Tardáguila A. Management of ureteropelvic junction obstruction with high-pressure balloon dilatation: long-term outcome in 50 children under 18 months of age. Urology 2013;82:1138–43.
Lam JS, Cooper KL, Greene TD, et al. Impact of hydronephrosis and renal function on treatment outcome: antegrade versus retrograde endopyelotomy. Urology. 2003;61:1107–12