Nefrectomia de urgencias por traumatismo renal durante la práctica del esqui / Sports renal injury: Emergency nephrectomy

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Robotic kidney transplantation: one year after the beginning.

INTRODUCTION: Kidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease (ESRD). To reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. Our aim is to evaluate surgical and functional results on 17 cases of robotic-assisted kidney transplantation (RAKT) performed at the same institution. MATERIALS AND METHODS: From July 2015 to June 2016, we performed 17 cases of RAKT from living donors in pre-emptive patients, who underwent laparoscopic nephrectomy. A prospective pilot study was made at Fundació Puigvert (Barcelona), evaluating functional and surgical outcomes. In this series, we considered the functional results, surgical outcomes and complications rates. RESULTS: Seventeen patients successfully underwent RAKT, in particular surgical console time was 181 min (150-200) with vascular suture time 42 min (32-48), and estimated blood loss <70 ml. Overall ischemia time was 98.9 min (84-140). No patient was converted to open transplantation. No major surgical intra-operative complications were observed. The mean post-operative serum creatinine level 160 µmol/L (81-479). We reported a case of delayed graft function (DGF), one case of graft arterial thrombosis and one case of intraperitoneal hematoma. No anastomosis revision and wounds infections occurred. CONCLUSION: RAKT with regional hypothermia appears to be a safe surgical procedure in a properly selected group of patients. The potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients.

Mini-percutaneous nephrolithotomy with high-power holmium YAG laser in pediatric patients with staghorn and complex calculi.

INTRODUCTION: Shock wave lithotripsy (SWL) is the treatment of choice for most cases of renal lithiasis in children. Some cases, however, are refractory to SWL and may be associated with anatomic and metabolic changes or a large stone burden. In these circumstances, mini-percutaneous nephrolithotomy (mini-PCNL) is an option. OBJECTIVE: The aim was to assess the safety and efficacy of high-power holmium YAG (Ho:YAG) laser in mini-PCNL for staghorn calculi. PATIENTS AND METHODS: The clinical records relating to 35 mini-PCNLs (Table) performed between January 2008 and December 2012 in 33 patients (27 boys and 6 girls; mean age 7 years, range 2-18 years) were retrospectively reviewed. Twenty-two (66.7%) of the patients had undergone a previous SWL (28.6% three sessions). The mini-PCNL puncture technique used involved fluoroscopic guidance with the C arm at 0-90° in the supine position. An 18F tract was used. Stone fragmentation was performed with a high-power Ho:YAG laser (Lumenis 100 W). RESULTS: Ten of the mini-PCNLs (28.6%) were right sided, and 25 were left sided (71.4%). Stones were located in the lower calyceal group in 64% of patients and in the renal pelvis in 50%. The mean stone size was 4.46 cm(2) (range 3-13.20 cm(2)). The number of stones varied between one and 20, and 83.3% were radiopaque. The laser was set at 70 W (range 50-100 W) (3.5 J/pulse with a frequency of 20 pulses/s). The mean surgical time was 150 min. In 78% of patients, complete stone clearance was achieved, and the overall stone-free rate rose to 85% when residual stones were treated with either SWL or retrograde intrarenal surgery. No perioperative complications were seen. DISCUSSION: There are few reports in the literature concerning the use of a high-power laser for treatment of complex stones and the few that do exist relate to adults have similar results, showing it to be highly effective and safe, with low morbidity. Some limitations of the present study must be acknowledged. It was retrospective and a relatively small number of patients were included. However, randomized prospective studies are required to confirm our findings and conclusions. CONCLUSION: In the pediatric population, mini-PCNL with high-power Ho:YAG laser is feasible and safe and represents the technique of choice for complex renal stones.

Quality of life in female patients with bladder exstrophy-epispadias complex: Long-term follow-up.

INTRODUCTION: Bladder exstrophy-epispadias complex (BEEC) is a congenital malformation that requires multiple surgeries during childhood and life-long follow-up. It often presents with conditions that have the potential to impact quality-of-life (QoL) and psychosocial functioning of affected patients, such as incontinence and sexual dysfunction. The aim of this study is to examine the QoL, urinary continence, sexual function, and overall health in a long-term series of female patients with BEEC. METHOD: A retrospective review was performed of female patients with BEEC born between 1964 and 1996. Thirty-three patients were asked to complete four validated questionnaires to evaluate their QoL regarding urinary continence and sexual activity (ICIQ, Potenziani-14, and PISQ-12 questionnaires). Nineteen patients completed and returned the questionnaires. The overall QoL was assessed with the SF-36 questionnaire, and demographics were evaluated. Statistical analysis was performed to compare the general QoL with that of the general population. RESULTS: The median age of the patients was 26 years (range 18-50) (Table). A low to moderate impact of urinary incontinence on QoL was reported by 30% of patients in the ICIQ. Also as a result of urinary incontinence, 84% of patients reported a moderate to severe impact on their sexual lives. Twelve patients got married with eight gestations and five births. SF-36 reported general QoL comparable with that of the general population in five out of eight items. Differences were seen in the mental health, emotional role, and physical functioning items (p < 0.001). The main factors for the differences were poor body image, anxiety, and urinary incontinence. A satisfactory social life was reported by 70% of patients. CONCLUSION: Questionnaire studies on BEEC consistently report a high rate of patients not answering, 43% in the present study. The rarity of the disease determines a small sample size, which diminishes statistical power and could potentially conceal small differences with controls. Despite these limitations, the present findings are consistent with previous studies on BEEC with validated QoL questionnaires: adult women with BEEC suffer psychosocial impact mainly from incontinence, and also from gynecological complications, but their resilience and coping mechanisms allow them to achieve a quasi-normal QoL. Female patients with BEEC reported a normal QoL in five of eight items in the SF-36 questionnaire. Urinary incontinence was the main factor for the moderately decreased QoL according to specific questionnaires.

Mini-laparoscopic live donor nephrectomy with the use of 3-mm instruments and laparoscope.

PURPOSE: To analyze our preliminary outcomes on the use of 3 mm instruments for laparoscopic live donor nephrectomy (LLDN). METHODS: Our series includes thirteen patients, who underwent LLDN using 3-mm instruments and laparoscope and 5-mm transumbilical trocar. The patients were followed at 7 and 14 days from discharge and were specifically asked about their cosmetic satisfaction. At follow-up, the recipient graft function was controlled, as well as the donor's cosmetic results. Eight months after surgery, all thirteen patients were asked to fill out the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). RESULTS: All patients presented good recovery after surgery. Regarding cosmetic outcomes, the donors expressed their satisfaction toward the minimal incision size and optimal esthetic results at 7 and 14 days from discharge home. The low scores on each section of the PSAQ confirmed the favorable outcomes. Early graft function was satisfactory at 1 and 3 months after the kidney transplantation. Furthermore, there were no major complications in the recipients. CONCLUSIONS: Our persistent positive results with the use of 3-mm instruments during LLDN support this technique as a good alternative to the standard laparoscopic approach for minimizing the incision site, while maintaining safety and excellent clinical outcomes. The fact that the general laparoscopic standards are maintained could make this approach a very attractive alternative to the other minimally invasive approaches for live donor nephrectomy. The hope is in that the higher degree of satisfaction in the donor population demonstrated in this study may likely enhance living kidney donation.

Juvenile granulosa cell tumor of the testis: a bilateral and synchronous case. Should testis-sparing surgery be mandatory?

Granulosa cell tumor of the testis is an infrequent stromal cell tumor that can be distinguished into adult and juvenile, the latter being more common. Juvenile granulosa cell tumor of the testis is a rare pathologic finding, accounting for 1.2%-3.9% of prepubertal testicular tumors. It is considered as a benign stromal sex cord tumor and is usually unilateral. Although radical surgery was previously considered the treatment of choice, testis-sparing surgery is now recommended in all cases where applicable. We report a bilateral synchronous juvenile granulosa cell tumor in a 6-month-old child treated with testis-sparing surgery and provide a review of the literature.

Long-term follow-up of transitional cell carcinoma of the bladder in childhood.

BACKGROUND: Bladder tumours are rare in children, with only 0.38% of cases occurring in the first two decades of life. OBJECTIVE: To describe a long-term follow-up series of nine urothelial bladder tumours in children. PATIENTS AND METHODS: We carried out a retrospective study covering the period from 1988 until 2005. We found that during this time, urothelial tumours had been diagnosed at our centre in eight patients (9 tumours) younger than 18 years old who reported an episode of haematuria. Diagnosis was attained through renal and bladder ultrasound in 85% of patients, and through cystoscopy under anaesthesia in 15%. All cases were treated by means of transurethral resection of the bladder, with ensuing follow-up using renal and bladder ultrasound and urinary cytology. MEASUREMENTS: Patients characteristics and outcome are evaluated. RESULTS: Single exophytic tumours were present in seven (87.5%) of the patients, located either in the lateral wall or in the trigone; one patient showed two small tumours. The pathology was as follows: two G1Ta, one G1T1, one G2T1, and five G2Ta. There were no recurrences. CONCLUSIONS: Transitional cell carcinoma in childhood is of low grade and low aggressiveness. It has a good prognosis and recurrences are infrequent. We suggest performing a urinary cytology/cystoscopy every 6 months the first 2 years and urinary cytology/bladder ultrasound once a year.

[Vesico-ureteral reflux, endoscopic management]. / Reflujo vesicoureteral. Tratamiento endoscópico.

INTRODUCTION: Vesico-ureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract and is distinguished in primary and secondary. It is present in 25-70% of children who have a urinary tract infection (UTI) associated with pyelonephritis, the association between UTI and VUR predisposes children to have renal scarring with consequent alteration of the functionality until chronic renal failure. MATERIAL AND METHODS: We realized a review of the literature on the endoscopic treatment of vesico-ureteral reflux analyzing the different techniques, materials used for endoscopic injection, indications and complications described in the literature. RESULTS: Over 100 articles we found on the endoscopic treatment of reflux with indications, complications and outcomes in the short, medium and long term. Of these we selected the most recent and current European and American Guidelines. CONCLUSIONS: Endoscopic treatment of reflux has become gradually the technique of choice for the primary treatment of vesico-ureteral reflux associated with pyelonephritis or urinary tract infections and permits to delay the use of open surgery.

Reflujo vesicoureteral: Tratamiento endoscópico / Vesico-ureteral refux, endoscopic management

El refujo vesicoureteral (RVU) es el fujo de orina desde la vejiga hasta el tracto urinario superior. Está presente en el 25% al 70% de los niños con infección urinaria asociada a pielonefritis. Se realizó una revisión de la bibliografía sobre el tratamiento endoscópico del RVU analizando las técnicas, los materiales utilizados, las indicaciones y las complicaciones descritas. De los artículos encontrados, se seleccionaron los más recientes y las Guías Europeas y Norteamericanas. El tratamiento endoscópico del refujo, que se ha impuesto progresivamente como técnica de elección para el tratamiento primario del RVU asociado a pielonefritis o a infecciones, permite retrasar el recurso a la cirugía.

Introduction. Vesico-ureteral refux (VUR) is defned as the retrograde fow of urine from the bladder to the upper urinary tract and is distinguished in primary and secondary. It is present in 25-70% of children who have a urinary tract infection (UTI) associated with pyelonephritis, the association between UTI and VUR predisposes children to have renal scarring with consequent alteration of the functionality until chronic renal failure. Material and methods. We realized a review of the literature on the endoscopic treatment of vesico-ureteral refux analyzing the different techniques, materials used for endoscopic injection, indications and complications described in the literature. Results. Over 100 articles we found on the endoscopic treatment of refux with indications, complications and outcomes in the short, medium and long term. Of these we selected the most recent and current European and American Guidelines. Conclusions. Endoscopic treatment of refux has become gradually the technique of choice for the primary treatment of vesico-ureteral refux associated with pyelonephritis or urinary tract infections and permits to delay the use of open surgery.

Reflujo vesicoureteral: Tratamiento endoscópico / Vesico-ureteral refux, endoscopic management

El refujo vesicoureteral (RVU) es el fujo de orina desde la vejiga hasta el tracto urinario superior. Está presente en el 25% al 70% de los niños con infección urinaria asociada a pielonefritis. Se realizó una revisión de la bibliografía sobre el tratamiento endoscópico del RVU analizando las técnicas, los materiales utilizados, las indicaciones y las complicaciones descritas. De los artículos encontrados, se seleccionaron los más recientes y las Guías Europeas y Norteamericanas. El tratamiento endoscópico del refujo, que se ha impuesto progresivamente como técnica de elección para el tratamiento primario del RVU asociado a pielonefritis o a infecciones, permite retrasar el recurso a la cirugía.(AU)

Introduction. Vesico-ureteral refux (VUR) is defned as the retrograde fow of urine from the bladder to the upper urinary tract and is distinguished in primary and secondary. It is present in 25-70% of children who have a urinary tract infection (UTI) associated with pyelonephritis, the association between UTI and VUR predisposes children to have renal scarring with consequent alteration of the functionality until chronic renal failure. Material and methods. We realized a review of the literature on the endoscopic treatment of vesico-ureteral refux analyzing the different techniques, materials used for endoscopic injection, indications and complications described in the literature. Results. Over 100 articles we found on the endoscopic treatment of refux with indications, complications and outcomes in the short, medium and long term. Of these we selected the most recent and current European and American Guidelines. Conclusions. Endoscopic treatment of refux has become gradually the technique of choice for the primary treatment of vesico-ureteral refux associated with pyelonephritis or urinary tract infections and permits to delay the use of open surgery.(AU)

Reflujo vesicoureteral. Tratamiento endoscópico. / [Vesico-ureteral reflux, endoscopic management].

INTRODUCTION: Vesico-ureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract and is distinguished in primary and secondary. It is present in 25-70

of children who have a urinary tract infection (UTI) associated with pyelonephritis, the association between UTI and VUR predisposes children to have renal scarring with consequent alteration of the functionality until chronic renal failure. MATERIAL AND METHODS: We realized a review of the literature on the endoscopic treatment of vesico-ureteral reflux analyzing the different techniques, materials used for endoscopic injection, indications and complications described in the literature. RESULTS: Over 100 articles we found on the endoscopic treatment of reflux with indications, complications and outcomes in the short, medium and long term. Of these we selected the most recent and current European and American Guidelines. CONCLUSIONS: Endoscopic treatment of reflux has become gradually the technique of choice for the primary treatment of vesico-ureteral reflux associated with pyelonephritis or urinary tract infections and permits to delay the use of open surgery.

ESR1 promoter polymorphism is not associated with nonsyndromic cryptorchidism.

The ESR1 promoter microsatellite (TA)n was reported as a potential functional polymorphism. In a case-control study, we were unable to demonstrate any association between (TA)n and nonsyndromic cryptorchidism in Italian and Spanish study populations.

Laparoscopic kidney transplantation.

We present the details of the first laparoscopic transplantation of a kidney from a living, related donor, performed April 16, 2009. Surgical and functional results were acceptable. Surgical time was 240 min (53 min for vascular suture), with blood loss of 300 cm(3) and a hospital stay of 14 d. Serum creatinine at discharge was 73 mmol/l. Laparoscopic kidney transplantation is a complex technique that requires previous experience in vascular and laparoscopic surgery. As with all novel procedures, technical modifications will be required to formalize its use and detailed comparisons will need to be made with standard procedures.

Efficiency of endoscopic treatment for vesico-ureteric reflux in adults.

OBJECTIVE: To evaluate the results of our experience with endoscopic management of vesico-ureteric reflux (VUR) in adults, and to describe factors and complications that might contribute to the failure of the technique. PATIENTS AND METHODS: Between 1992 and 2006, 21 patients (17 women and four men; mean age 32.1 years, SD 15.6) had endoscopic treatment for VUR (14 unilateral and seven bilateral ureteric units, UU). Patients previously operated for VUR were excluded. The VUR grades were II, III, IV and V in 10, 12, five and one UUs, respectively. The main indication for treatment was a history of repeated episodes of acute pyelonephritis (61%). Complications after surgery were evaluated. RESULTS: The success rate of the first endoscopic treatment was 69%, and was 81% after the second. Two UUs with grade IV VUR were endoscopically managed for a third time with complete resolution. Only one UU with grade V VUR required open surgery. The success rate for VUR grades II, III and IV after the first treatment was five of eight, 12/12 and one of five, respectively. After the second treatment the success rate increased to seven of eight and two of five for grades II and IV, respectively. There were no complications related to the intervention. Factors related to a failure of technique were duplex ureter and dysfunctional voiding in eight UUs (seven patients). CONCLUSIONS: The endoscopic management of VUR in previously untreated adult patients is a simple and efficient technique, with low comorbidity.

Kidney transplants in patients with bladder augmentation: correlation and evolution.

OBJECTIVE: To review the literature, analyse the evolution of kidney transplants (KT) in patients with bladder augmentation (BA) and investigate the relation between BA and KT. MATERIALS AND METHODS: Six patients with a history of severe lower urinary tract dysfunction and BA, received a KT at our Unit between 1993 and 2003. Three had moderate renal failure at the moment of the BA. The remaining three had end stage renal failure. RESULTS: With a follow-up of 7 years (mean) we have a patient survival of 100% and a graft survival of 83%. No complications occurred between the BA and the KT. The few KT complications were not related to BA. CONCLUSION: When a bladder dysfunction is present, it should be treated before KT. In noncompliant bladders, BA is the best treatment. This can be done to try to avoid end stage renal failure or only to prepare the lower urinary tract for reception of the transplant. The presence of a BA did not worsen the evolution of the KT.

[Congenital bladder diverticula and vesicoureteral reflux]. / Divertículos vesicales congénitos en la infancia y reflujo vésicoureteral.

OBJECTIVES: To analyze our series of primary congenital diverticula (PCD) and their association with vesicoureteral reflux. METHODS: We have taken care of 23 children with PCD. Eleven of them had big diverticula (> 2 cm) and twelve small. In the first group, 4 children had vesicoureteral reflux and 5 in the second group. In group A, ureteral reimplantation was performed at the time of diverticulum excision. Nor diverticula neither refluxes were operated in group B. RESULTS: We analyze separately results in both groups. Group A: Patients were operated including diverticulum excision. There were not recurrences except in one case with Ehler-Danlos Syndrome. No reimplanted ureter showed postoperative reflux. Nevertheless, one case with multiple bladder diverticula without reflux presented reflux after the excision of several diverticula without reimplantation. Group B: Small diverticula did not undergo surgery Spontaneous outcome of reflux was similar to that of the general population without diverticula. CONCLUSIONS: Bladder diverticula are frequently associated with vesicoureteral reflux. The presence of reflux is not an absolute condition for surgical or endoscopic treatment. When diverticula are big in size (Group A) the indication for surgery comes from recurrent infection or voiding disorders, not from reflux. If they undergo surgery, ureteral reimplantation is performed in the case they had reflux or for technical reasons like bladder wall weakness. When diverticula are small (Group B) the presence of reflux does not condition treatment, being the rate of spontaneous resolution similar to the general population.

Divertículos vesicales congénitos en la infancia y reflujo vésico-ureteral / Congenital bladder diverticula and vesicoureteral reflux

Objetivo: Analizar nuestra serie de divertículos congénitos primarios (DVCP) y su relación con el reflujo vésico-ureteral. Métodos: En 10 años hemos asistido a 23 niños con DVCP. Once eran divertículos grandes (más de 2 cm de diámetro) y doce eran pequeños. En el primer grupo, 4 niños tenían reflujo vésico-ureteral y en el segundo cinco. En el grupo A se reimplantaron los uréteres refluyentes al extirpar el divertículo. En el grupo B no se operó en ningún caso el divertículo o el reflujo. Resultados: Analizaremos por separado los resultados de ambos grupos. Grupo A: fueron operados, extirpándose el/los divertículo/s. Sólo recidivaron los divertículos en el caso de síndrome de Ehlers-Danlos. En todos los casos reimplantados no hubo reflujo post-operatorio. Sin embargo, apareció un reflujo post-cirugía en un caso de vejiga polidiverticular, a la que se le extirparon varios divertículos sin reimplante. Grupo B: los divertículos pequeños no fueron operados. La evolución espontánea del reflujo fue similar a la de la población general sin divertículos. Conclusiones: Los divertículos vesicales se asocian con frecuencia a reflujo vésico-ureteral. La presencia del reflujo no constituye, en el momento actual, un condicionante absoluto del tratamiento quirúrgico o endoscópico. Cuando los divertículos son grandes (Grupo A), la indicación quirúrgica está dada por las infecciones recidivantes, los trastornos miccionales y no por la presencia de reflujo. Si se operan, se reimplanta el uréter porque tiene reflujo o porque hay razones técnicas de debilidad parietal. Cuando los divertículos son pequeños (Grupo B), la presencia de reflujo no condiciona el tratamiento, siendo la tasa de resolución espontánea similar a la de la población general (AU)

Objectives: To analyze our series of primary congenital diverticula (PCD) and their association with vesicoureteral reflux. Methods: We have taken care of 23 children with PCD. Eleven of them had big diverticula ( 2 cm) and twelve small. In the first group, 4 children had vesicoureteral reflux and 5 in the second group. In group A, ureteral reimplantation was performed at the time of diverticulum excision. Nor diverticula neither refluxes were operated in group B. Results: We analyze separately results in both groups. Group A: Patients were operated including diverticulum excision. There were not recurrences except in one case with Ehler-Danlos Syndrome. No reimplanted ureter showed postoperative reflux. Nevertheless, one case with multiple bladder diverticula without reflux presented reflux after the excision of several diverticula without reimplantation. Group B: Small diverticula did not undergo surgery. Spontaneous outcome of reflux was similar to that of the general population without diverticula. Conclusions: Bladder diverticula are frequently associated with vesicoureteral reflux. The presence of reflux is not an absolute condition for surgical or endoscopic treatment. When diverticula are big in size (Group A) the indication for surgery comes from recurrent infection or voiding disorders, not from reflux. If they undergo surgery, ureteral reimplantation is performed in the case they had reflux or for technical reasons like bladder wall weakness. When diverticula are small (Group B) the presence of reflux does not condition treatment, being the rate of spontaneous resolution similar to the general population (AU)

Primary congenital bladder diverticula in children.

OBJECTIVES: To present the symptoms, treatment, evolution, and pathologic findings of primary (nonobstructive) diverticula in childhood. Primary (nonobstructive) diverticula are not frequent in childhood. Bladder diverticula have classically been defined as "hernias of the mucosa through muscular fibers of the bladder wall." METHODS: From September 1985 through September 2005, we treated 11 children categorized has having primary congenital bladder diverticula. At diagnosis, their ages ranged between 7 months and 9 years (mean 4.6 years). Ten were boys and one was a girl. The main reason for consultation was febrile urinary infection (n = 5), recurrent urinary infections (n = 3), enuretic syndrome (n = 1), gross hematuria (n = 1), and pain in the right iliac fossa (n = 1). One child had Ehlers-Danlos syndrome. All the diverticula were larger than 2 cm in diameter. Of the 11 children, 10 underwent surgery. Clinical observation was chosen for the 9-month-old infant. RESULTS: All 10 operated children had developed favorably at a follow-up of 2 to 20 years (mean 9.3). The 9-month-old child continued under observation for 5 years. We observed no diverticulum recurrence and no postoperative vesicoureteral reflux in the reimplanted children. Pathologic examination was performed of the excised diverticula in 7 cases, and muscular fibers were found in all of them; however, most of the fibers were very fine, particularly at the dome of the diverticulum. CONCLUSIONS: The results of our study have shown that urinary tract infection is the most common symptom of bladder diverticula. Surgical treatment provided good results, without any recurrence or morbidity. The bladder diverticula were lined with fine muscular fibers.

Primary obstructive megaureter: initial experience with endoscopic dilatation.

BACKGROUND AND PURPOSE: Primary obstructive megaureter (POM) without vesicoureteral reflux has classically been managed by open surgery with ureteral reimplantation. We present seven patients with POM who were treated endoscopically with balloon dilatation of the distal ureter. PATIENTS AND METHODS: Six boys and one girl with POM were treated from June 2000 through July 2004. Six of the cases were diagnosed prenatally when ectasia of the urinary tract was seen on ultrasound scans. The postnatal diagnosis was also achieved by ultrasonography, along with a diuretic isotopic renogram with MAG-3, intravenous urography, and filling cystography. The age at surgery was 1 to 3 years. In all cases, a compact 10F infant cystoscope with a 5F working channel was used. Dilatation of the stenotic area was performed under fluoroscopic monitoring. A 4F dilating balloon was used, which was insufflated to between 12 and 14 atm for 3 to 5 minutes, and disappearance of the narrowed ring was verified. A Double-J catheter was positioned and withdrawn 2 months after the procedure. Clinical, analytical, and imaging follow-up was carried out with ultrasonography and MAG-3 renography. RESULTS: The mean follow-up of the patients is 31 months (range 12-56 months). Their clinical progress was highly satisfactory. Five patients exhibited reduced obstruction at MAG-3. One patient needed a second dilatation, and the obstructive curve improved after this additional procedure. One of the patients presented with a febrile urinary infection after the dilatation, but there were no other complications. CONCLUSIONS: Endoscopic management of POM by balloon dilatation has yielded very good results in the short term. Longer follow-up will enable us to determine the final indications for this treatment.