Conservative Treatment in Primary Neonatal Megaureter

Abstract

The authors report their experience on 22 neonates (14 males and 8 females) with primary megaureter. In 18 patients a prenatal diagnosis was available, in the other four the diagnosis was suspected during a neonatal ultrasound screening. The dilatation involved the right ureter 7 times and the left 13 times, in 2 patients it was bilateral. Intravenous urography documented a type I ureteral dilatation in 2 renal units (8.3%), a type II in 9 (37.5%) and a type III dilatation in 13 (54.2%). Radionuclide scan (Tc99m DTPA) demonstrated in all the renal units with megaureter a stable function. From diuretic renal scan, non-obstruction appeared in 19 (83%), obstruction in 2 (8.5%) and an equivocal result in the remaining 2. Antibiotic prophylaxis was administered to all patients. Follow-up period ranged from 18 to 54 months. The 2 obstructed megaureter were surgically treated. Other 2 patients with type III dilatation and non-obstructing megaureter underwent surgery at 18 and 24 months of age respectively. The remaining 17 patients were all conservatively treated. The 2 patients with type I dilatation resolved spontaneously. Of 9 patients with type II megaureter the dilatation resolved in 6 patients and 3 patients had a good reduction. In the remaining 8 patients with type III megaureter, the dilatation resolved in 5 cases and 3 patients had only a fair reduction. The renal function (> 40%) remained stable in all the patients.

Renal Function and Urine Drainage after Conservative or Operative Treatment of Primary (Obstructive) Megaureter in Infants and Children

“…Moreover, it was revealed that the UNC patients had a more distinct dilatation of the ureter initially than the ''non-UNC'' group. For group 1 we determined 9 ± 3 mm (4-34) proximally and 7±3 mm (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) distally. The maximum pre-operative diameter of the 16 neoimplanted ureters later was 15 ± 3 mm (6-25) proximally and 15 ± 5 mm (6-23) distally.…”

“…According to today's knowledge that a high percentage of the primary obstructive megaureters normalizes without impairment of renal function, the conservative approach is justified in severe asymptomatic cases too [1,3,15,[18][19][20].…”

“…The hypothesis was put forward that the primary megaureter of the fetuses and the neonates constitutes a separate entity compared to the primary obstructive megaureter of the elder child [1,2]. The original operative treatment concept has now been replaced by a conservative treatment approach mainly [1,[3][4][5][6][7][8]. However, the differentiation between a non-relevant dilatation of the urinary tract (non-obstructive, non-reflux megaureter) and a relevant obstruction jeopardizing the renal function (obstructive megaureter) is important [2].…”

Complications and long-term outcome of primary obstructive megaureter in childhood

“…With modern ultrasound techniques, about 40% of POMs are discovered prenatally [6] and the fraction of symptomatic children decreased to 22-50% [7,8]. In the 1990s, several reports documented the high rate of spontaneous regression of prenatally diagnosed POM [7,[9][10][11][12][13]. Even though chronic renal failure has been described in rare cases of adults with bilateral POM [14], the lack of functional impairment of the great majority of kidneys with POM is an additional argument for taking a conservative approach [15].…”

Bilateral primary Non-Obstructive and Non-Refluxing Megaureter in Child: Diagnosis by Non-Radiation Imaging Modalities

“…[6,7] CONCLUSION Primary megaureters should be categorized properly for the management purpose. Our case was without any reflux and obstruction and was treated conservatively in the beginning before the surgical intervention was contemplated.…”