Long-term follow up of antenatally diagnosed megaureters

Chertin, Boris; Pollack, Avner; Koulikov, Dmitry; Rabinowitz, Ron; Shen, O.; Hain, Daniel; Hadas-Halpren, Irit; Shenfeld, Ofer Z.; Farkas, Amicur

doi:10.1016/j.jpurol.2007.11.013

Cited by 61 publications

(29 citation statements)

References 9 publications

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“…Due to the primarily conservative stepwise approach, only 13 renal units (23%) were operated upon. This rate is within the range reported in recent publications (seven and 46%) [16][17][18]25].…”

Section: Discussionsupporting

confidence: 91%

“…The consensus paper recommends a differentiated conservative approach, where operations are advised only after proven relevant obstruction on MAG3 isotope scan or in case of major complications. There are few studies examining the long-term outcome of patients with mainly conservative treatment [16][17][18] and no studies on the specific management approach of the consensus paper yet. In the largest POM outcome study published to date, which included 78 patients followed-up over an average period of 6.5 years, 85% of cases were still treated surgically [5].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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We assessed the clinical outcome of 49 children with 56 primary obstructive megaureters (POM) treated with the primarily conservative approach recommended by the 2001 German consensus guidelines. POM occurred more often in boys (71%) and on the left side (67%). Forty-three POM (77%) were treated conservatively. Four kidneys underwent immediate surgery and nine of 52 kidneys managed primarily conservatively worsened subsequently, requiring surgery. Urinary tract infections (UTI) were the most common complication (mean 1.3 per patient), with frequent hospital admission (45%). During the first year of life, the incidence of UTIs was 55% less during prophylactic antibiotic treatment (0.94 vs.0.42 UTIs per year, p < 0.05). Spontaneous regression occurred in 80% of POMs with dilated non-obstructive renogram, but in <20% with intermediate or relevant obstruction. All megaureters with <8.5 mm sonographic diameter regressed, but none over 15 mm. Eight patients had a poor outcome (partial kidney function <40% (n = 6), renal atrophy (n = 3)), but in seven of the patients, these findings were already present postnatally. In summary, the long-term outcome of POM appears favorable with mainly conservative treatment. UTI as the most common complication was 55% lower with antibiotic prophylaxis in infants. Adverse outcome was more closely related to congenital kidney hypoplasia than to degree of obstruction.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…Chertin and associates [15] retrospectively evaluated a cohort of 79 children with prenatally detected megaureters managed over a period of 18 years. In total, 25 children (31%) underwent surgery at a mean age of 14.3 months for indications which included reduced function, increasing dilatation and persistently obstructed curve on radionuclide scans.…”

Section: Non-refluxing Megauretermentioning

confidence: 99%

Prenatal diagnosis: What do we know of long-term outcomes?

Thomas

2010

Journal of Pediatric Urology

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“…Approximately 10e30% of children will ultimately require surgery for their megaureters [7,10,15]. Common operative indications include severe reflux, recurrent infection, significant obstruction and decreased renal function.…”

Section: Discussionmentioning

confidence: 99%