Primary obstructive megaureter in infants: our experience with endoscopic balloon dilation and cutting balloon ureterotomy.

The management of primary obstructive megaureter (POM) is usually conservative, at least in the first year of life. Nevertheless, in high-grade POMs with increasing dilation, obstructive patterns found at renography, or cases involving decreased renal function, there is a clear indication for surgery. From January 2009 to March 2013, 12 patients, aged 6 to 12 months (mean 8 months), were treated endoscopically for POM. At the procedure, a clear stenotic ring was identified in 10 of the 12 patients, and a simple endoscopic high-pressure balloon dilation (EHPBD) was well performed in 7 patients. In the three cases with persistent ring, a cutting balloon ureterotomy (CBU) was then performed, resulting in the immediate and complete disappearance of the stenosis. In two cases, no ring could be seen at the procedure, and they showed no improvement at the follow-up. The mean follow-up was 21 months. Considering the whole series of patients treated endoscopically, the overall success rate of EHPBD+CBU was 83%. Patients with POM can be treated endoscopically. In the case of a persistent ring that is unresponsive to EHPBD, CBU seems to provide a valid definitive treatment of POM.