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Acute pain crisis as a presentation of primary megaureter in children
Christopher B Anderson1, Stacy T Tanaka, John C Pope
1Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN 37232, USA. c.anderson@vanderbilt.edu
Insights
Primary megaureter can cause flank pain, similar to Dietl's crisis. About 17% of patients experienced pain, with 10% in acute crisis, often requiring surgery for symptom relief.
Area of Science:
- Pediatric Urology
- Urologic Oncology
- Nephrology
Background:
- Congenital ureteropelvic junction obstruction is a known cause of flank pain (Dietl's crisis).
- Primary megaureter, a condition of ureteral dilation, can present with similar symptoms.
- Understanding the pain presentation of primary megaureter is crucial for diagnosis and management.
Purpose of the Study:
- To investigate the presentation and outcomes of primary megaureter in patients experiencing flank pain.
- To compare the pain presentation of primary megaureter to Dietl's crisis.
- To evaluate the effectiveness of surgical and conservative management for symptomatic primary megaureter.
Main Methods:
- Retrospective review of 465 megaureter patients (1993-2009).
- Inclusion of 103 patients with primary megaureter, focusing on those with pain.
- Exclusion of patients with secondary megaureter.
Main Results:
- 17% of primary megaureter patients presented with pain; 10% experienced an acute pain crisis.
- Median age at presentation was 77 months; some required urgent intervention.
- Surgery resolved pain in all treated patients; observation success varied.
Conclusions:
- Pain and acute pain crises are significant presentations of primary megaureter.
- Surgical intervention effectively resolves pain associated with primary megaureter.
- Primary megaureter should be considered in the differential diagnosis of flank pain in children.
Purpose:
Congenital ureteropelvic junction obstruction may present with flank pain, commonly referred to as a Dietl's crisis. We report on a similar presentation of primary megaureter.
Methods And Materials:
We identified all patients with any diagnosis of megaureter treated at our institution between 1993 and 2009 (n = 465). We included 103 patients with primary megaureter and, of these, identified patients presenting with pain. All patients with secondary megaureter were excluded.
Results:
Seventeen patients (20 megaureters) presented with pain and 10 (13 megaureters) presented with an acute pain crisis. Median age at presentation was 77 months. Seven children initially presented to the emergency department for evaluation and two of them required urgent stent placement for intractable pain. Obstruction was diagnosed in 8 patients. Six patients underwent ureteral reimplantation. Four patients were initially observed: one failed observation at 12 months due to worsening hydronephrosis and required surgery, one was lost to follow up, and two are still successfully being followed. All patients who underwent surgery had pain resolution.
Conclusion:
In this contemporary cohort, approximately 17% of patients with primary megaureter presented with pain and 10% presented with an acute pain crisis. Most presenting in acute pain required surgery, which resolved presenting symptoms.
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