Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study

Drlík, Marcel; Flögelová, Hana; Kubát, Martin; Jan, Tomášek; Pavel, Zerhau; Šmakal, Oldřich; Novák, Ivo; Komarc, Martin; Kočvara, R

doi:10.1016/j.jpurol.2016.05.025

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…However, only 3 infants in our series with a DRF <40% underwent surgical intervention, which did not reach statistical significance on univariate and multivariable analyses. Furthermore, in their study of 25 patients (DRF ranging from 10 to 40%) who were allocated to receive either conservative or surgical management, Drlik et al (11) observed no significant differences between the groups and noted a similar increase of DRF in both groups. They thereby concluded that an initial, low DRF in an asymptomatic, stable patient should not be an independent indication for surgery.…”

Section: Discussionmentioning

confidence: 96%

“…The transition from surgical to non-surgical initial management in the treatment of children with PM has been well-documented, and a non-operative approach has been shown to be safe and effective for the majority of prenatally-diagnosed PM patients (5, 6, 11–13). Although studies have documented high rates of resolution, indicators for surgical intervention remain controversial (14).…”

Section: Discussionmentioning

confidence: 99%

“…The median age at baseline/diagnosis in our patient group was 2 months, which supports the findings reported by Rubenwolf et al (14) who found that the age of diagnosis was significantly lower in children diagnosed between 2005 and 2009 (4.1 months) in comparison to those diagnosed between 1986 and 1990 (25.3 months). This decreasing trend in age at diagnosis reflects the impact of fetal ultrasonography and the changing management paradigm of PM, whereby children are being increasingly diagnosed on prenatal ultrasound rather than after becoming symptomatic at a later age (11, 14). A younger age at diagnosis has the potential to substantially impact patients, as we are able to identify early those at increased risk for fUTIs, and begin CAP before the development of such illnesses.…”

Section: Discussionmentioning

confidence: 99%

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Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Dekirmendjian

Braga

2019

Front. Pediatr.

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Background: The risk of febrile urinary tract infection (fUTI) in children with primary non-refluxing megaureter (PM) has been extensively studied in the literature, however, a paucity of information exists regarding risk factors for surgical intervention and spontaneous resolution. We sought to analyze data from our prospectively collected PM cohort to determine risk factors that would predict surgery and resolution in this population. Methods: Patients with PM were identified from our prospectively-collected prenatal hydronephrosis (HN) database from 2008 to 2017. Primary outcomes included surgical intervention and hydroureter resolution. Spontaneous resolution was defined as ureteral dilation <7 mm at last follow-up. Age at presentation, gender, development of fUTI, HN grade [low (SFU I/II) vs. high (SFU III/IV)], anteroposterior diameter (APD) measurements and ureteral diameter at baseline and last follow-up were recorded. Univariate and multivariable analyses (binary logistic and Cox regression) were performed. Results: Of 101 patients, 86 (85%) were male, and 80 (79%) had high grade HN. Median age at baseline and last follow-up were 2 (0–23) and 29 (2–107) months, respectively. Overall, 23 (23%) patients underwent surgery at a median age of 22 (3–35) months. Mean ureteral diameter was larger in surgical patients vs. those treated non-surgically (14 ± 4 vs.11 ± 3 mm; p < 0.01). Of the 78 (77%) non-surgical patients, 43(55%) showed resolution of their ureteral dilation at a median age of 24(4–56) months. Survival analysis demonstrated that 12 patients resolved by year 1, 22 by year 2, 30 by year 3, 40 by year 4, and 43 by year 5. However, when considering resolution as APD <10 mm, 62(79%) children resolved their HN by last follow-up (29 months). Univariate and multivariable analyses ( Table 1 ) revealed that high-grade HN at baseline, development of fUTI, and ureteric dilation ≥14 mm were significant risk factors for surgical intervention. Cox regression ( Figure 2 ) found that ureteral dilation <11 mm was the only independent risk factor significantly associated with PM resolution ( Table 2 ). Conclusion: Patients with PM and high-grade HN, as well as individuals with ureteral dilation ≥14 mm and fUTI were more likely to undergo surgical intervention. Ureteral dilation <11 mm was the only independent risk factor significantly associated with spontaneous resolution of PM.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Dekirmendjian

Braga

2019

Front. Pediatr.

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“…Early surgery indications in asymptomatic and radiologically stable patients should not solely rely on an initially low DRF. 14,15 The time required for spontaneous resolution increases with the severity of antenatally detected hydronephrosis. Factors such as time of presentation, hydronephrosis degree, and distal ureter dilation influence spontaneous resolution rates, which can be up to 71% for grades I-III and 55% for grade IV, at 3 years old.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous resolution and the role of endoscopic surgery in the treatment of primary obstructive megaureter: a review of the literature

Isac,

Danila,

Ionescu

2023

Pediatr Med Chir

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The megaureter accounts for almost a quarter of all urinary tract dilations diagnosed in utero and is the second leading cause of hydronephrosis in newborns, following pyeloureteral junction obstruction. The current standard treatment for progressive or persistent, symptomatic primary obstructive megaureter is ureteral anti-reflux reimplantation, which can be associated with ureteral remodeling or plication. Due to the associated morbidity, postoperative recovery challenges, and the complications that may arise from the open surgical approach, there has been a natural inclination towards validating new minimally invasive techniques. This study reviews the literature, extracting data from three major international databases, from 1998 to 2022. Out of 1172 initially identified articles, only 52 were deemed eligible, analyzing 1764 patients and 1981 renal units. Results show that 65% of cases required surgical intervention, with minimally invasive techniques constituting 56% of these procedures. High-pressure endoscopic balloon dilation was the preferred endourologic technique. The degree of ureterohydronephrosis is considered one of the factors indicating the need for surgery. There is an inverse relationship between the diameter of the ureter and the likelihood of spontaneous resolution. Conditions such as renal hypoplasia, renal dysplasia, or ectopic ureteral insertion strongly indicate a poor prognosis. Endoscopic surgical techniques for treating primary obstructive megaureter can be definitive, firstline treatment options. In selected cases, they might be at least as effective and safe as the open approach, but with advantages like quicker recovery, fewer complications, shorter hospital stays, and reduced costs.

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“…proposed the inclusion criteria for endoscopic treatment in 2018 as the presence of symptoms and significant ureteral dilatation > 10mm or marked renal dysfunction on scintigraphy [ 6 ]. It is underlined as a matter of debate in the literature, that the endoscopic intervention may be a treatment choice in asymptomatic patients that present impaired renal function on the renal scintigraphy [ 7 ]. Once the endoscopic treatment is chosen, the DJ stent remains in the ureter for approximately 2 months while prophylactic antibiotics are administered [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic treatment of obstructive ureterohydronephrosis in children

Demiri¹,

Lambropoulos²,

Mouravas³

et al. 2020

Pan Afr Med J

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Obstructive ureterohydronephrosis in childhood population is a matter of debate between paediatric surgeons and paediatricians, as far as the therapeutic protocol that should be applied. Close observation, chemoprophylaxis, endoscopic and surgical approaches are the universally used techniques that provide quality of life in the paediatric patients. Undoubtedly, “the less is more” even when we have to encounter obstructive ureterohydronephrosis in children. Herein, we present a short case series where the endoscopic management of obstructive uropathies proved to be therapeutic without any need of surgical intervention.

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Isolated low initial differential renal function in patients with primary non-refluxing megaureter should not be considered an indication for early surgery: A multicentric study

Cited by 7 publications

References 13 publications

Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Spontaneous resolution and the role of endoscopic surgery in the treatment of primary obstructive megaureter: a review of the literature

Endoscopic treatment of obstructive ureterohydronephrosis in children

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