Refluxing ureteral reimplant as temporary treatment of obstructive megaureter in neonate and infant

An obstructive megaureter identified in the neonatal period can be managed using a number of techniques, with the primary goal being to minimize the potential for further injury to the affected kidney. We describe our experience with refluxing ureteral reimplantation as a novel method for temporizing the obstructive megaureter.

Three patients identified prenatally with severe hydroureteronephrosis were confirmed following delivery to have an obstructive ectopic ureter. Unilateral obstruction was identified in 2 patients (1 female, 1 male). The third patient was a female with bilateral single system ectopic ureters. Treatment consisted of anastomosing the ureter proximal to the obstruction to the dome of the bladder in a freely high grade refluxing fashion. All of the patients were placed on antibiotic suppression after surgery.

All patients demonstrated improved drainage of the affected kidney(s) following surgery. One female patient with unilateral obstruction had a poorly functioning kidney that showed no improvement of renal function 6 months following refluxing reimplantation, and laparoscopic nephrectomy was performed. The male patient with unilateral obstruction had adequate function with a significantly decreased ureteral diameter 1 year following refluxing ureteral reimplant, and a ureteral reimplantation without tapering was performed. The female patient with bilateral obstruction had 1 breakthrough urinary tract infection 6 months after surgery and now awaits second stage repair.

Refluxing ureteral reimplantation is a safe, easy, beneficial and well tolerated means of temporizing the obstructive megaureter. This technique allows time for the child to mature, while accurately establishing renal function and preparing for a definitive surgical solution.