1310 / Endoscopic balloon dilation for primary obstructive megaureter

SPAIN
Classification of the PSP
Type of Patient Safety Practice Not Evaluated
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Surgical / Invasive procedures
Other There is no specified text here
Topic of the reported practice
Clinical guidelines or pathways
Aim and the benefit of the Patient Safety Practice
 
Ureteral tapering and reimplantation is an established
treatment for persistent or progressive primary
obstructive megaureter (POM) but may result
in complications and morbidity. Use of a less invasive
technique involving endoscopic balloon dilation appears
very interesting.
The objective is to determine if endoscopic balloon dilation for POM is effective in
the long term as well as to assess complications of
the procedure.
Description of the Patient Safety Practice
 
From June 2000 to February 2010, a total of 19 patients and
20 ureters were treated with the endoscopic balloon dilation
for POM. The patients comprised 16 boys and 3 girls,
with a mean age at surgery of 17 months (range: 1e44
months). Ten cases were left sided, eight right sided and
one bilateral. Eleven cases were diagnosed prenatally.
Under general anesthesia, and a single dose of antibiotic
prophylaxis with cefonicid, 8e9.5 Fr cystoscopy was carried
out with a 4-5 Fr working channel. The ureterovesical stenosis
was bypassed with a flexible guidewire (0.021-in. Fixed Core
Wire Guide, Cook Medical, Bloomington, IN, USA) introduced
up to the renal pelvis and filled with radiologic contrast,
confirming the diagnosis of megaureter and defining the
anatomy. A 3e5 Fr dilating balloon catheter (the balloon
length was 4 cm and the diameter was 6 mm) (STAR PTA
balloon catheter, Optimed, Medizinische Instrumente Gmbh,
Ettlingen, Germany) was insufflated to 12 or 14 atm until
disappearance of the stenotic ring (from 3 to 6 min waiting
time). The dilation never had to be prolonged for more than
5 min to see that the stenotic ring had disappeared. The
stenotic ring was always visible before dilation.
The main technique details are in our report.
Results
There were no perioperative complications (Clavien I). All
19 patients had a smooth postoperative course; there were
no morbidities. There were no difficulties in ureter catheterization
or any incidence of ureteral stent migration. The mean follow-up was 6.9 years (range: 3.9e13.3 years). One patient was lost to follow-up after the procedure.
There was significant improvement in hydroureteronephrosis
in all patients except the one who
required a second dilation. Significant differences were
observed in hydronephrosis grade before and after endoscopic
dilation (P < 0.001) .
Renal function was preserved in 18 patients (95%),
without subsequent deterioration. No significant differences
were observed in preoperative and postoperative
renal function (DRF 41.26% vs 41.50%, P Z 0.59).
At the last follow-up, all patients remain asymptomatic
and showed no signs of UTI, lithiasis, or pyeloureteral dilation.
No instances of obstruction were observed on MAG-3
renogram.
The cost of endoscopic balloon dilatation varies from hospital to hospital because it is based on the cost of staff and the cost per hour of the operating room. This technique is performed by a single surgeon and as specific material it is necessary a dilatation balloon (291,20€ balloon). Please let us know if you need further details, we can send you the exact cost of the endoscopic dilatation balloon at our center.
Conclusion
Endoscopic balloon dilatation has been shown to be a safe,
feasible, and less-invasive procedure that has good outcomes.
It is an effective treatment with few postoperative
complications at long-term follow-up and it may be
considered first-line treatment in the management of POM
in children. It also avoids unnecessary bladder surgery and
the associated complications.
Attachment of relevant written information and/or photos, as appropriate
2015113007454028425_WP4_megaureter (2).pdf
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Team level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
No
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Quantitative
Enclosure of a reference or attachment in case of published evaluation's results
Journal of Pediatric Urology (2015) 11, 37.e1e37.e6
2015113007333618425_WP4_MEGAURETER.pdf
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Yes
Specification of implementation in another health care setting(s)
Hospital
Successful implementation's level  of this Patient Safety Practice across settings
Yes, across multiple specialities within the same setting
Involved health care staff
 
Physicians
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
Yes
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
There is no specified text here
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
Not relevant
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: PILAR BAXARIAS
Country: SPAIN
Organisation: FUNDACIÓ PUIGVERT
E-mail: pbaxarias@fundacio-puigvert.es
Phone: There is no specified text here
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