Long-Term Outcomes of Balloon Dilation in Pediatric Distal Ureteral Stenosis Across Age Groups.

PURPOSES: The gold standard for treating primary obstructive megaureter is ureteral reimplantation, with ongoing debate surrounding its use in patients under 1 year of age. In most primary obstructive megaureter cases requiring urinary diversion, ureterostomy is favored over pyelostomy and nephrostomy. Another described alternative would be the refluxing ureteral reimplantation. Balloon dilation, established as effective and safe in adults with ureteral strictures, may offer an alternative for pediatric patients. This study aims to evaluate pre- and postoperative parameters of balloon dilation in distal ureteral segment stenosis among pediatric patients across age groups and to identify independent parameters influencing treatment success.

METHODS

The medical records of newborns (age, 0-28 days; n = 19), young infants (age, 28 days to 6 months; n = 29), and children (age, 6 months to 11 years; n = 29) of Han Chinese pediatric patients from the Guangdong Women and Children Hospital, Guangzhou, China, from December 8, 2020, to November 5, 2023, with distal ureteral segment stenosis who underwent balloon dilatation (size from 8 to 10.5 F) were included in the analysis.

FINDINGS: The prevalence of distal ureteral segment stenosis is higher in males than females (58 vs 19) and that was higher on the left lateral side in both boys and girls than right or both lateral sides (P = 0.0375). The therapeutic effect of balloon dilation in distal ureteral segment stenosis is effective across all age groups (P < 0.05 for all) and especially reported to be more effective in newborns, followed by young infants and children regarding anterior and posterior pelvic diameter, renal parenchymal thickness (thinnest point), ureter diameter (widest point), and urine white blood cells (P < 0.05 for all). The treatment effect of balloon dilation correlated with age (P = 0.0412), hydronephrosis (P = 0.0481), renal cortical thickness (P = 0.0419), and ureteral dilation (P = 0.0491).

IMPLICATIONS: These findings suggest that balloon dilation may offer a manageable alternative for younger patients, especially newborns for distal ureteral segment stenosis, with age and specific anatomical factors influencing outcomes. Age, hydronephrosis, renal cortical thickness, and ureteral dilation were independent parameters for the treatment effect of balloon dilation in very young patients.