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Changing concepts in management of primary obstructive megaureter.
M A Keating1, J Escala, H M Snyder
1Department of Nuclear Medicine, Children's Hospital of Philadelphia, Pennsylvania.
The Journal of Urology
|August 1, 1989
Summary
Neonatal urinary tract dilatations, specifically primary obstructive megaureter, can often be managed conservatively. Utilizing technetium-99m diethylenetriaminepentaacetic acid renal scans helps differentiate cases, avoiding unnecessary surgery and promoting favorable outcomes.
Area of Science:
- Pediatric Urology
- Neonatal Medicine
- Nephrology
Background:
- Neonatal urinary tract dilatations pose significant management challenges in pediatric urology.
- Primary obstructive megaureter is a common diagnosis, with increasing detection due to antenatal screening.
Purpose of the Study:
- To evaluate the efficacy of conservative management for neonatal primary obstructive megaureter.
- To assess the role of technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA) renal scans in guiding treatment decisions.
Main Methods:
- Retrospective analysis of 44 renal units in 35 neonates diagnosed with primary obstructive megaureter over 6 years.
- Conservative management decisions based on 99mTc-DTPA renal scan extraction fraction to assess renal function.
- Sequential excretory urography and renal scans used for monitoring.
Main Results:
- 20 out of 23 antenatally diagnosed units (87%) were managed conservatively, including 16 moderate to severe cases.
- Conservative management led to improved dilatation in 15 megaureters without functional deterioration.
- 12 out of 21 symptomatic or incidentally discovered neonatal megaureters were managed conservatively, with only 2 requiring surgery.
Conclusions:
- Conservative management is effective for a significant proportion of neonatal primary obstructive megaureters, particularly when guided by renal function assessment.
- 99mTc-DTPA renal scan extraction fraction is a valuable tool for differentiating obstructive implications and guiding non-operative treatment.
- Neonatal primary obstructive megaureter may represent a distinct clinical entity compared to previously described cases.