Balloon dilatation for failed pyeloplasty is it a valid alternate option in pediatric age group: A comparative retrospective study.

Abstract

Introduction: In pediatric patients, the preferred intervention following a failed pyeloplasty is a surgical challenge. Balloon dilatation is a minimally invasive option with low complication rates. However, redo-pyeloplasty provides workable and effective outcomes but is more technically demanding. The study demonstrates our experience with redo-pyeloplasty for previously failed pyeloplasty compared to balloon dilatation.

Methodology: A total of 298 patients underwent pyeloplasty between 2013 and 2022. Out of these 19 patients (6%), aged 11 months to 12 years (median age 7 years) had failed pyeloplasty; 11 patients underwent redo-pyeloplasty (robotic in 63.6%[7] and laparoscopic in 36.4% [4]), and eight patients were treated with balloon dilatation. Ultrasound and renogram were performed to evaluate the patient's outcomes. Success was defined as improving hydronephrosis in 6 weeks, 3 months, 6 months, and 1-year follow-up without an obstructed curve in renogram. The aim is to evaluate and assess the success rate and outcomes of redo-pyeloplasty compared to antegrade/retrograde balloon dilatation in pediatric patients with a previously failed pyeloplasty.

Results: All patients who underwent redo pyeloplasty had successful outcomes (100%). However, of patients who underwent balloon dilatation, only 1 (12.5%) patient had a successful outcome, and seven patients (87%) did not show improvement. Patients' age, gender, and laterality of ureteropelvic junction obstruction were insignificant among both groups.

Conclusion: We demonstrated that balloon dilatation has a meager success rate in managing failed pyeloplasty cases. Redo-pyeloplasty procedures, either robotic or laparoscopic, have the potential to offer superior results.