Although rare, primary megaureter is responsible for up to 20% of hydronephrosis cases in neonates. In children, any ureter greater than 7 mm in diameter is considered a megaureter based on measurements in fetuses greater than 30 weeks gestation and children dec 21, 2019 megaureter, the accepted term for the dilated ureter, is divided into primary congenital and secondary categories. Teklali praticien hospitalier, chirurgie pediatrique. The different types of megaureters are described below. The megaureter can be mobilized via an intravesical, extravesical, or combined approach. When primary megaureter is obstructive, the degree of obstruction is variable and seems to improve in many cases over time. Almost onequarter of the children referred to a pediatric urologist for obstructive uropathy suffer from an obstructive megaureter. Postnatal us and urography reveal a variable degree of dilation of the. The ureter is too narrow where it enters the bladder, causing a blockage of urine flow at that. Megaureter primario no refluyente detectado prenatalmente anales. This can be due to a short vertical intramural segment, congenital paraureteric diverticulum, ureterocoele with or without associated duplicated collecting system, etc. Megaureter is a medical anomaly whereby the ureter is abnormally dilated. Laparoscopic nephroureterectomy for adult patient with. Urolithiasis in an adult with primary obstructive megaureter.
Pdf laparoscopic ureterovesical repair for megaureter treatment. Totally laparoscopic repair of primary obstructive megaureter. Renal function and urine drainage after conservative or. Most often, this condition is detected incidentally on prenatal us. Refluxing primary megaureter is a result of an abnormal vesicoureteric junction, which impedes the normal antireflux mechanisms. Congenital megaureter is an uncommon condition which is more common in males, may be bilateral, and is often associated with other congenital anomalies. Alternatively, you can download the file locally and open with any standalone pdf reader. Most cases of megaureter are now first detected with prenatal ultrasound and then diagnosed after birth. Primary megaureter is due to obstructed or refluxing vesicoureteral junction, while secondary megaureter is caused by bladder outlet obstruction. Primary obstructive megaureter with giant ureteral stone. The absence of longterm followup data, however, makes it difficult to establish the indication for an endoscopic approach. Cirugia del megaureter obstructivo primitivo del nino o.
If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser. An alternative treatment for obstructive and refluxing obstructive megaureter with ureterovesical junction maintenance through. The procedure consisted in incising the stenotic portion of the ureter longitudinally and maintaining its posterior wall attached to the bladder, the anterior wall of the ureter was anastomosed transversally to the bladder mucosa in order to liberate. A 29yearold female with a complaint of abdominal distension was referred to our hospital.
A megaureter is an anomaly with a dilated ureter of more than 78 mm, the further division is made according to the cause. Common causes include spinal dysraphism and neurogenic bladder, which may elevate detrusor pressure to over 40 cm. Megaureter refluyente megaureter obstructivo megaureter no. Concomitant endoureterotomy and dextranomerhyaluronic acid. Each category is further subdivided into 1 refluxing nonobstructing megaureter and 2 nonrefluxing obstructing megaureter. Primary megaureter results from an abnormal proportion of muscle fibers and fibrous tissue in the distalmost 3 to 4 cm of the ureter. A megaureter large ureter is when a ureter is wider than threeeighths of an inch. Megaureter and other congenital ureteral anomalies treatment.
Megaureter is an abnormality of one or both of the ureters of a child. Seven were diagnosed with obstructive megaureter and one with obstructive refluxing megaureter. The two important questions about megaureter are whether there is reflux backwash of urine causing the megaureter or whether there is blockage at the ureterovesical junction causing megaureter figure 1. The urinary tract is affected in 2% of cases, and the ratio of bladder to ureter to urethra involvement is 40. The first cgm was reported by chaterjee sk in 1964. In this type, the urine flows back up the ureter from the bladder. These distinctions are based on radiographic and clinical findings. A megaureter means big ureter and is a descriptive term, not a diagnosis. The primary obstructive megaureter is caused by a prevesical aperistaltic ureter segment, which causes a dilatation of the prestenotic ureter.
The retrospective analysis covering the years 1994 to 2000 comprised children at an age of 07 years with 35 pmu. Megaureteres, estudio y conducta medica megaloureters, study. Intravenous pyelography revealed a huge left megaureter with a stone in the lower end and grade v hydronephrosis. Reimplantation techniques are similar to those used for correcting primary vur.
Cirugia del megaureter obstructivo primitivo del nino o del. Jan 17, 2020 megaureter secondary to severe vur or obstruction is usually managed with ureteral reimplantation. This can result from an abnormality of the ureter itself primary or from the bladder being blocked secondary. Ureters are the two funnelshaped tubes that carry urine from the kidneys to the bladder. Unilateral congenital giant megaureter with renal dysplasia. Article in english, italian simoni f1, vino l, pizzini c, benini d, fanos v. Tratamiento del megaureter congenito obstructivo primario. The patient was considered carrier of this last pathology taking into account the. Endoureterotomy for treatment of primary obstructive. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. We examined renal function and urinary drainage of children with primary megaureter pmu in dependence on conservative or operative treatment. This backflow, known as vesicoureteral reflux, expands the ureter. The incidence of endometriosis is approximately 10% to 20% in women of reproductive age.
Some cases present clinically during childhood with abdominal pain, hematuria, andor urinary tract infections. Goslingthe vesicoureteric junction in three cases of primary obstructive megaureter associated with. Initially 8 cases presented with reflux, 9 with megaureter and reflux, 20 with megaureter without reflux, 5 cases of ureterocele with duplication. Pdf laparoscopic ureterovesical repair for megaureter.
The term megaureter does not define a specific pathological condition, because it can be due to different underlying abnormalities. To describe a new approach to the treatment of primary obstructive megaureter pomu using endoscopic endoureterotomy. Megaureter may also be incidentally discovered later in life on imaging studies. There is a growing interest in minimally invasive treatment of primary obstructive megaureter pom in children.
Megaureter is defined as a ureter that exceeds the upper limits of normal size. A megaureter refers to an expanded or widened ureter that does not function normally. She had a history of being treated for pyelonephritis three times. Secondary obstructive megaureter secondary obstructive megaureter represents an obstructive process secondary to elevated intravesical pressure of some other cause. Hidronefrosis perinatal diagnostico y tratamiento revista ucm. A 19yearold male patient was admitted with flank pain, which had lasted intermittently for four years. She hoped for surgical intervention before becoming pregnant.
The size of a megaureter is usually greater than 7 millimeters in. The megaureter megacystis syndrome is an extreme form of the primary refluxing megaureters in which massive reflux prevents effective bladder emptying because urine is passed back and forth between the ureters and bladder. By computed tomography and retrograde pyelography, she was diagnosed with adult left primary megaureter. Cirugia del megaureter obstructivo primitivo del nino o del adulto. A left ureterolithotomy, left nipple ureteroneocystostomy, and.
1358 1488 1040 1016 294 1345 993 1080 1410 1432 118 1190 213 147 1391 183 1542 1064 240 1417 1085 1386 1194 1414 1383 1471 1631 1349 932 1119 895 1091 407 93 1531 922 359 1165 70 359 868 594 300 1036 1010 880 335