[Primary megaureter in the newborn period: making the case for a temporary splint-free cutaneous ureterostomy]

The term "megaureter" is used to describe a markedly dilated ureter, irrespective of its underlying anatomic abnormality. Primary megaureters categorised as type I and II according to the Pfister-Hendren classification resolve spontaneously during the first years of life, whereas severely dilated type III megaureters have no potential to resolve on conservative management. Regarding this small group of very severely dilated type III megaureters, we recommend a two-step surgical approach: in a first step, we place a temporary splint-free ureterocutaneostomy for early disobstruction. In a second step, we perform the actual corrective surgery with closure of the incontinent urinary diversion when the patient is approximately one year old, a point in time when bladder function is more mature. With this strategy, ultrasound imaging provides all important information until the corrective surgery is performed. A voiding cystourethrogram (VCUG) to rule out reflux and a MAG-3 diuretic renography can supplement the diagnostic work-up before the ureterocutaneostomy is closed.