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Factors associated with spontaneous resolution and surgery in non-obstructive non-refluxing megaureters
Gizem Yildiz1,2, Meral Torun Bayram1, Husne Didem Turker3
1Department of Pediatric Nephrology, Dokuz Eylül University Medical Faculty, Izmir, Turkey.
Summary
Non-obstructive non-refluxing (NONR) megaureters in children often resolve spontaneously, particularly when ureteral diameter is less than 11mm. However, larger diameters (≥14mm) indicate a higher risk of complications and need for surgical intervention.
Area of Science:
- Pediatric Urology
- Medical Imaging
- Nephrology
Background:
- Non-obstructive non-refluxing (NONR) megaureters are a congenital condition affecting the urinary tract.
- Predicting spontaneous resolution versus the need for surgical intervention is crucial for optimal patient management.
Purpose of the Study:
- To analyze clinical and radiological criteria for predicting surgical approach or spontaneous resolution in children with NONR megaureter.
- To evaluate the outcomes of observational monitoring versus surgical intervention.
Main Methods:
- Retrospective analysis of hospital records for children diagnosed with NONR megaureter.
- Evaluation of patient demographics, presenting complaints, follow-up duration, associated urological abnormalities, and complications.
- Assessment of ureteral and renal pelvis diameters, and renal unit function using 99mTc-MAG3 scintigraphy.
Main Results:
- Spontaneous resolution was observed in 15/20 prenatal cases versus 2/7 postnatal cases (OR 7.5).
- Resolution rates were higher with ureteral diameter <11mm (OR 10.9) and renal pelvis anteroposterior diameter ≤10mm (OR 19.2).
- Surgical intervention was more frequent for ureteral diameter ≥14mm (OR 22.0), associated with higher rates of febrile UTIs, renal scarring, and reduced function.
Conclusions:
- Asymptomatic NONR megaureters warrant observational management.
- Favorable spontaneous resolution is linked to smaller ureteral (<11mm) and renal pelvis (≤10mm) diameters.
- Ureteral diameter ≥14mm predicts complications and the need for surgical intervention, including febrile UTIs, renal scarring, and decreased renal function.
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