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Congenital obstructed megaureters in early infancy: diagnosis and treatment
C A Peters1, J Mandell, R L Lebowitz
1Division of Urology, Children's Hospital, Boston, Massachusetts.
Insights
Early surgical repair of congenital obstructed megaureter in infants improves kidney function and prevents damage. This study highlights successful outcomes with early intervention for this common congenital uropathy.
Area of Science:
- Pediatric Urology
- Congenital Uropathies
- Neonatal Surgery
Background:
- Maternal ultrasonography has altered the presentation of congenital uropathies.
- Congenital obstructed megaureter is a significant condition affecting infants.
- Early detection impacts the timing and management of surgical correction.
Purpose of the Study:
- To evaluate the outcomes of surgical correction for primary obstructed megaureter in infants.
- To compare outcomes based on prenatal versus postnatal diagnosis.
- To assess the long-term functional and structural urographic improvement.
Main Methods:
- Retrospective study of 47 infants under 8 months with primary obstructed megaureter.
- Surgical correction performed in 42 infants with moderate to severe obstruction.
- Nonoperative management for 5 infants with mild obstruction.
Main Results:
- Surgical correction at a mean age of 1.8 months (prenatal diagnosis) vs. 3.8 months (postnatal diagnosis).
- All surgically treated infants showed urographic improvement; 8 experienced postoperative reflux.
- Nonoperative management was successful for mild cases; 2 required later surgical repair.
Conclusions:
- Early surgical repair of obstructed megaureters in infancy enhances renal drainage.
- Intervention before symptoms or infection can prevent renal damage.
- Excellent results are achievable with meticulous surgical technique and follow-up.
Abstract:
Fetal screening during maternal ultrasonography has changed the mode and age of presentation of congenital uropathies, particularly congenital obstructed megaureter. We studied 47 infants less than 8 months old with primary obstructed megaureter. Surgical correction in 42 patients with moderate to severe obstruction was performed at a mean age of 1.8 months in those detected prenatally and 3.8 months in those presenting after birth. All infants showed functional and structural urographic improvement with a mean followup of 2.3 years. Reflux was seen postoperatively in 8 patients, which subsided spontaneously in 3, continues to be followed in 2 and resulted in repeat reimplantation in 3. Five infants had mild obstruction, which was managed nonoperatively and 2 showed progressive obstruction, which required repair at ages 20 and 28 months. Repair of obstructed megaureters in early infancy improves renal drainage and offers the potential for preventing renal damage before the development of symptoms or infection. With proper attention to detail, excellent results may be achieved.