Pelviureteric obstruction in children treated by retrograde ureteroplasty

Identification of the narrow lumen of the ureter using a Fogarty catheter during laparoscopic pyeloplasty

It is difficult to identify the narrow sites of the ureter from the outside while carrying out laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. We developed and named a new method, the Fogarty test, to identify the narrow sites of the ureter using a Fogarty catheter. A 4- to 5-Fr Fogarty catheter was inserted through an incision in the pelvis to the proximal ureter, inflated with air and withdrawn gently to determine resistance. The narrow lumen of the ureter was identified under direct vision and spatulated by laparoscopic scissors. This procedure was carried out repeatedly until the ureter was fully spatulated. By using the Fogarty test, we can visualize the narrow position and length of the ureter under direct vision, and confirm whether it is fully spatulated or not. This technique is very simple and easy to carry out. We believe it is useful for sufficient spatulation of intrinsic ureteral stricture, especially in patients where multiple narrow sites exist.

Retrograde ureteroplasty using balloon dilatation in children with pelviureteric obstruction

Congenital and acquired pelviureteric junction obstruction (PUJ) were treated with balloon dilatation, using a Fogarty/Gruntzig catheter introduced through the cystoscope in 11 children (12 renal units). Stents were not used, and the hospitalization period was only 1 day for uncomplicated cases. Follow-up (maximum period, 4 1/2 years) has shown better drainage and function for all. In one child, who had solitary left kidney, acute obstruction developed; the patient underwent temporary percutaneous nephrostomy. Macroscopic hematuria was noted in one case, resulting in a 3-day hospital stay. Technical problems, advantages, and disadvantages are discussed. Retrograde ureteroplasty using balloon dilatation is a simple and effective procedure for children in whom the obstructed PUJ is in lower part of the pelvis.