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Published on: January 7, 2019
Symptomatic and complicated adult and adolescent primary obstructive megaureter--indications for surgery: analysis,
A K Hemal1, M S Ansari, D Doddamani
1Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Adult primary obstructive megaureter requires aggressive surgical management. While most patients improve after surgery, those with bilateral megaureters and advanced renal failure have poor outcomes.
Area of Science:
- Urology
- Adult Medicine
Background:
- Primary obstructive megaureter is rare in adults.
- It warrants aggressive surgical management distinct from pediatric cases.
Purpose of the Study:
- To analyze the clinical presentation, management, and outcomes of adult primary obstructive megaureter.
Main Methods:
- Retrospective study of 55 adult patients treated between 1989 and 2001.
- Data collected included clinical presentation, renal function, imaging, treatment, complications, and follow-up.
Main Results:
- 50 renoureteral units required ureteral reimplantation, 33 with tailoring.
- Endoscopic techniques and nephroureterectomy were used in some cases.
- Most patients improved, but 5 with bilateral megaureters had uremia, with 2 deaths.
Conclusions:
- Adult primary obstructive megaureter is typically symptomatic and requires surgery.
- Complications like stones and kidney dysfunction are common.
- Surgical outcomes are poor for bilateral cases with advanced renal failure.
Objectives:
Primary obstructive megaureter is an uncommon presentation in adult patients. Although not reported frequently in published studies, the anomaly exists and warrants aggressive surgical management in contrast to its presentation in children.
Methods:
This study was composed of 55 patients (47 with unilateral and 8 with bilateral megaureters) with adult primary obstructive megaureter who were treated from January 1989 to December 2001. Their clinical presentation, renal function, radiologic data, treatment, complications, and follow-up were studied.
Results:
Of the 55 patients, 36 were male and 19 were female (age range 13 to 52 years). All patients were symptomatic except two. Forty-four patients (50 renoureteral units) required ureteral reimplantation, with tailoring in 33. Five patients were treated with endoscopic techniques (ureteral meatotomy in 3 and ureteroscopic retrieval of ureteral calculi in 2). Four patients required nephroureterectomy for nonfunctioning kidneys. Associated renal calculi were managed by extracorporeal shock wave lithotripsy and pyelolithotomy and ureteral calculi by endoscopic methods or calculi removed at the time of ureteroneocystostomy. All but 4 patients showed improvement in hydroureter and hydronephrosis and developed no complications during the follow-up period of 1 to 12 years (mean 7). Five patients with bilateral megaureters had uremia. Only one improved after surgery with adequate drainage and 2 patients died despite reimplantation.
Conclusions:
Most adult patients with megaureter are symptomatic. Complications such as stone formation and deranged function of the affected kidney are common and almost all require surgical intervention. Surgery in those with bilateral megaureters with advanced renal failure is mostly unrewarding.
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