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Primary megaureter: results of surgical treatment
Gunnar Aksnes1, Reisuke Imaji, Paddy A Dewan
1Urology Unit, Royal Children's Hospital, Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Victoria, Australia.
Background:
The aim of this study was to assess the clinical and radiological outcome after surgical treatment for primary -megaureter.
Methods:
A retrospective analysis of 16 patients who had reimplantation of 17 primary megaureters between January 1997 and April 2001 was performed. Patients who had additional urinary tract pathology were not included in this study. The intent of the study was to focus on the complex range of data points that were used to reach the decision to operate.
Results:
Six of eight patients with febrile urinary tract infections prior to surgery have been without infections postoperatively. One patient who presented with daytime wetting has less wetting postoperatively, and one baby who presented with failure to thrive and postfeed vomiting, is feeding well postoperatively. On ultrasound investigation, the median diameter of the megaureter prior to operation was 11 mm (range 6-24 mm). One month after the operation, dilatation of the ureter could no longer be demonstrated in 10, was reduced in six, and increased in one of 17 ureters. Three months postoperatively, hydroureter was no longer detected in 14 and was reduced in three. In comparison, the hydronephrosis 1 month postoperatively was reduced in six, unchanged in seven and worse in four out of 17 kidneys, and 3 months after the operation, hydronephrosis was reduced in 13 and was unchanged in four compared with preoperative findings. Renograms at 3 months postoperatively showed free drainage in the 11 kidneys with impaired drainage preoperatively, and drainage continued to be normal in all six kidneys with normal drainage preoperatively. Median pre-operative renographic split function was 47% (range 39-54%), and was not significantly changed 3 months after the operation.
Conclusions:
When the decision to surgically intervene was made on a multifactorial basis, reimplantation of a primary mega-ureter resulted in improved clinical status, reduced dilation of the ureter and renal pelvis, and free drainage of the upper urinary tract.