A pediatric case of ureteropelvic junction obstruction treated with retrograde endopyelotomy

Abstract

右腎盂尿管移行部狭窄症の6歳女児に対し, アキュサイス尿管切開バルーン装置(軟性尿管カテーテル, 7Fr)を用いた逆行性エンドピエトロトミーを行いその実用性を検討した.全身麻酔下でアキュサイスカテーテルを膀胱鏡操作下に腎盂内にまで挿入し, 狭窄部を電気的に切開し更に同部位をバルーンで24Frまで拡張した.切開終了後にエンドピエトロトミー用尿管カテーテル(6/10Fr)を留置し, これを8週間後に抜去した.手術時間は45分間で, 患者は術後3日目に退院した.特に手術に関する合併症はなく, 術後8ヵ月目の経静脈性腎盂撮影と利尿レノグラムによる評価で, 水腎症の程度は改善していた

To determine the feasibility of retrograde endopyelotomy in the management of pediatric ureteropelvic junction (UPJ) obstruction, we treated one girl aged 6 years with the Acucise cutting balloon devise for symptomatic UPJ obstruction. The Acucise catheter (7 Fr, flexible) was placed by a cystoscope over a guide wire with fluoroscopic guidance under general anesthesia. After cutting the stenotic area electronically and dilation until 24 Fr for 10 seconds, a 6/10 Fr endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. Total operating time was 45 minutes and the child was discharged 3 days after the operation. There were no acute complications and short-term, follow-up 8 months after the operative results were satisfactory as determined by intravenous pyelography and diuretic renogram. UPJ obstruction in children may be treated by retrograde endopyelotomy with the Acucise catheter as well as adults. The principal potential advantage of this procedure is reduced morbidity as compared with antegrade endopyelotomy.