High pressure balloon dilatation of the ureterovesical junction in primary obstructive megaureter: Infectious morbidity

Abstract

Introduction: The objective of this study is to investigate the infectious morbidity associated with high-pressure balloon dilatation (HPBD) and an indwelling double J stent, in primary obstructive megaureter.

Methods: We reviewed the cases of 12 patients undergoing endoscopic treatment for primary obstructive megaureter from January 2012 to January 2015. The characteristics of the infection and data concerning the patient and the intervention were analyzed.

Results: The frequency of preoperative urinary tract infection (UTI) was 58%. The procedure was feasible in 100% of cases. Two patients required a second dilatation. One patient underwent Cohen's ureteral reimplantation after failure of the second dilatation. The frequency of postoperative UTI was 25%. All these infections occurred in patients with a double J stent. None of the patients had UTI after stent removal. None of the patients developed postoperative vesicoureteral reflux (VUR) after HPBD.

Conclusion: Endoscopic balloon dilatation has been shown to have good short- mid- and long-term outcomes. In our experience, the morbidity of this procedure mostly results from infections, exclusively related to the use of a double J stent. The placement of a double J stent has a significant medical and economic impact. A definitive decision about the utility of double J stents will require studies of further dilatation without the placement of a double J stent.

Level of evidence: 4.

Keywords: Double J stent; Febrile urinary tract infection; Iatrogenic vesicoureteral reflux; Infections urinaires fébriles; Mégauretère obstructif primitive; Primary obstructive megaureter; Reflux vésicourétéral iatrogène; Sonde JJ.