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Management of the primary obstructed megaureter (POM) and indication for operative treatment
M Stehr1, R Metzger, T Schuster
1Kinderchirurgische Klinik im Dr. v. Haunerschen Kinderspital, Munich, Germany. STEHR@HUB.tch.harvard.edu
Insights
Primary obstructed megaureter (POM) management in 42 patients showed that diuresis renogram (DR) is the most valuable diagnostic tool. Surgery was needed in only 9.6% of cases, with no observed loss of kidney function.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Surgical Management
Background:
- Primary Obstructed Megaureter (POM) is a congenital condition affecting the ureter.
- Prenatal hydronephrosis is a common initial finding in 41% of cases.
- Management involves a combination of diagnostic imaging and therapeutic interventions.
Purpose of the Study:
- To present the diagnostic and therapeutic management of Primary Obstructed Megaureter (POM).
- To evaluate the effectiveness of various diagnostic tools, particularly diuresis renogram (DR).
- To determine the criteria for surgical intervention and assess outcomes.
Main Methods:
- Retrospective analysis of 42 patients (53 ureteral units) with POM.
- Postnatal evaluation included ultrasound (US), voiding cystourethrogram (VCUG), intravenous pyelogram (IVP), and diuresis renogram (MAG-3).
- Renogram results were categorized by obstruction level; partial renal function was calculated.
Main Results:
- Initially, 17% showed functional obstruction, 64.2% equivocal, and 18.8% obstructive patterns.
- Two kidneys had significantly decreased partial function (20% and 26%).
- Surgery was performed in 9.6% of patients based on impaired function or lack of improvement.
Conclusions:
- Diuresis renogram (DR) is the most valuable diagnostic tool for POM.
- Conservative management is often successful, with surgery reserved for specific criteria.
- No loss of kidney function was observed during the follow-up period.
Abstract:
Presented is the diagnostic and therapeutic management of the primary obstructed megaureter (POM). 42 patients presented with 53 ureteral units (UU) of POM (5 females, 37 males, 36 neonates and 6 children aged 3 to 8 years). Of the 53 megaureters 10 UU (19%) were on the right and 27 UU(51 %)were on the left. 8 patients (19%)with 16 UU (30%)showed a bilateral abnormality. In 41% of the patients, hydronephrosis had been discovered by prenatal ultrasound. All patients were evaluated postnatally by ultrasound (US), voiding cysturethrogram (VCUG), intravenous pyelogram (IVP) and diuresis renogram (MAG-3) (DR). Due to the percentage of urinary drainage,the renogram results were classified into different categories:no obstruction, functional obstruction, equivocal and obstruction. A partial renal function was also calculated. Follow-up of the patients ranges between 5 to 48 months (mean: 22.1). All patients underwent serial US and serial DR were obtained in 36 patients. Initially, 9 (17%) UU showed a functional obstruction, 34 (64.2%) an equivocal and 10 (18.8%) an obstructive urinary drainage pattern. 2 kidneys showed a significant decreased partial function of 20, respectively 26%. Surgery was performed in an initial im-paired renal function with an obstructive pattern or in cases with normal function and at least equivocal urinary drainage pattern with no improvement or deterioration of the urinary drainage and/or function in the follow-up. Considering these criteria, 5(9.6%) patients needed surgery. No loss of kidney function has been observed in follow-up. DR is the most valuable diagnostic tool. Criteria interpreting the results are demonstrated in this article.