Should primary megaureter be treated d'emblée in the neonate?

Since 1969 Hendren and other AA. proposed a radical correction of high obstructive uropathy in neonatal age. This was accepted by most surgeons for pyelo-ureteral joint stenosis, but it may not be accepted in third grade refluent or nonrefluent megaureter. In such an eventuality the lesion may require transient ureterostomy or nephrostomy; this option is necessary in renal insufficiency, but it was not codified for unilateral defects. The results of immediate corrective surgery (Cohen or Politano-Leadbetter ureteral reimplantation) were recently evaluated in 103 patients with 141 primary megaureters. Ninety per cent of infants and children more than six months old recovered, while 6 per cent had fair results, 4 per cent poor results. Only sixty two per cent of infants under six months improved, while 35 per cent and 3 per cent had respectively fair and poor results. "Fair" results were represented by patients with unmodified renal condition (14 per cent) and patients who underwent two or three operations to obtain renal improvement (21 per cent). If the final outcome seems in any case positive, we think a two-stage operation in the third grade megaureter of the neonate is still preferable to a risk of complications and unforeseen reoperations.