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Should primary megaureter be treated d'emblée in the neonate?
A Ottolenghi1, S Campagnola, M Sulpasso
1Cattedra di Chirurgia Pediatrica, Università di Verona, Italia.
Summary
Radical correction for neonatal obstructive uropathy shows better outcomes in older infants. A two-stage approach may be preferable for third-grade megaureter to avoid complications.
Area of Science:
- Pediatric Urology
- Surgical Innovation
Background:
- Hendren's radical correction for neonatal obstructive uropathy, proposed in 1969, is widely accepted for pyelo-ureteral joint stenosis.
- However, its applicability to third-grade refluent or nonrefluent megaureter remains debated, sometimes necessitating transient ureterostomy or nephrostomy, especially in cases of renal insufficiency.
Purpose of the Study:
- To evaluate the outcomes of immediate corrective surgery (ureteral reimplantation) for primary megaureters in neonates and children.
- To compare the efficacy of immediate corrective surgery versus a staged approach for third-grade megaureter.
Main Methods:
- Retrospective evaluation of 103 patients with 141 primary megaureters who underwent immediate corrective surgery (Cohen or Politano-Leadbetter ureteral reimplantation).
- Analysis of surgical outcomes based on patient age (under six months vs. over six months) and megaureter grade.
Main Results:
- Ninety percent of infants and children over six months old achieved recovery, with 6% fair and 4% poor results.
- Only 62% of infants under six months improved, with 35% fair and 3% poor results. "Fair" results included unmodified renal condition (14%) or multiple reoperations (21%).
Conclusions:
- Immediate ureteral reimplantation yields high success rates in older infants and children with primary megaureters.
- For third-grade megaureter in neonates, a two-stage operation is considered preferable to mitigate risks of complications and reoperations, despite generally positive outcomes from immediate surgery.