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[Primary obstructive megaureter in infants: medical or surgical treatment? Apropos of 24 cases]
Insights
Early diagnosis of primary obstructive megaureter allows for conservative management. Many cases resolve with antibiotics and monitoring, deferring surgery until 12-18 months for better outcomes.
Area of Science:
- Pediatric Urology
- Neonatal Surgery
- Medical Imaging
Context:
- Primary obstructive megaureter is a congenital condition affecting the urinary tract.
- Diagnosis often occurs prenatally via ultrasound or postnatally due to urinary tract infections.
- Management strategies vary, with a need to balance surgical intervention with conservative approaches.
Purpose:
- To analyze the outcomes of conservative and surgical management in infants diagnosed with primary obstructive megaureter before three months of age.
- To evaluate the effectiveness of early antibacterial treatment and regular monitoring.
- To determine the optimal timing for ureteric reimplantation.
Summary:
- This study analyzed 24 infants with primary obstructive megaureter diagnosed before 3 months. Investigations included ultrasound, IVU, and MCU. 15 patients underwent surgery, while 9 were managed conservatively with antibiotics and monitoring.
- Results indicated that conservative management with delayed surgical reimplantation (12-18 months) can lead to complete resolution, even in severe cases.
- Early antibacterial treatment appeared to promote ureteric dilation regression.
Impact:
- Conservative management and delayed surgical intervention appear effective for primary obstructive megaureter, potentially reducing unnecessary early surgeries.
- Antibacterial therapy initiated early may aid in ureteric regression.
- Optimal surgical timing at 12-18 months offers technical advantages for ureteric reimplantation.
Abstract:
The authors analyse 24 cases of primary obstructive megaureter diagnosed before the age of 3 months. 18 were discovered by antenatal echography between 28 and 39 weeks, whereas 6 were detected by the occurrence of early urinary tract infection. Initial investigations included echography, intravenous urography and micturating cystouretrogram. Primary megaureter was bilateral in 14 cases, unilateral in 12. According to the urographic classification of Beurton, there were 12 ureters stage III, 12 stage II, 10 stage I. 15 patients were operated, 4 of them during the first months (2 reimplantations, 2 urinary diversions). 12 were submitted to later reimplantation at the mean age of 15 months, one had a non functioning kidney removed. 9 were non operated and treated conservatively by antibacterials and regular supervision. Results analysis evaluated according to radiological stage and treatment showed that in more cases, surgery should be differed initially. Complete clinical and radiological resolution is possible even in severe obstructions. Antibacterial treatment beginning at birth favorises regression of dilated ureter. Thus reimplantation should be deferred undercover of regular biological and radiological survey. The age of 12 to 18 months is the most technically favorable time to ureteric reimplantation.