Initial experiences with percutaneous and transurethral ablation of postoperative ureteral strictures in children.
A transurethral or percutaneous procedure was used in 11 children and 1 young adult in an attempt to correct obstruction at the site of previous pyeloplasty, ureteroenterostomy or vesicoureteral reimplantation into the bladder. When a guide wire could be passed through the obstructed segment a balloon would always pass over the wire. The balloon could then be inflated to dilate the narrowed area. Five patients in whom the obstruction was detected and treated in this manner within a few months after the initial operation exhibited relief of obstruction and these good results have persisted. The exception to this generalization is a 5-year-old girl who did not experience durable improvement in obstruction when treated 3 months after ureteral implantation. Four additional children with ureteral strictures diagnosed 1 to 4 years postoperatively also were not improved by dilation, even when a post-dilation stent (usually a double-J catheter) was used for 6 to 8 weeks. Two boys with recurrent ureteropelvic junction obstruction after pyeloplasty underwent percutaneous resection of the ureteropelvic junction. In 1 boy the hook electrode and cautery were used and stenosis recurred, apparently due to thermal injury. In the other boy a sharpened hook electrode was used to incise the ureteropelvic junction, which has stayed open for 18 months, and he is our longest followup.