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[Fold formations in the proximal ureter]
Insights
Ureteral membranes in children are typically benign and resolve on their own. These congenital anomalies, often diagnosed in infancy, rarely require surgical intervention and usually do not cause long-term kidney issues.
Area of Science:
- Pediatric Urology
- Congenital Anomalies
- Urogenital System Development
Context:
- Mucosal membranes of the proximal ureter are rare congenital anomalies.
- Diagnosed via intravenous urography in children aged 4 weeks to 11 years.
- Often identified within the first year of life, predominantly in males.
Purpose:
- To evaluate the natural history and clinical significance of ureteral membranes in pediatric patients.
- To assess the association with urinary tract infections (UTIs) and renal obstruction.
- To determine the necessity of urologic intervention for these anomalies.
Summary:
- Over 13 years, 28 children presented with ureteral membranes, with 61% diagnosed in the first year.
- Associated urogenital anomalies were noted in 7 cases; 45% showed minor signs of obstruction.
- Urinary tract infections occurred in 50% of cases, but surgical correction was never needed.
- Follow-up revealed recurrent UTIs in only 2 patients, with normal renal function and kidney size.
- Ureteral membranes are considered harmless, transitory anomalies of the growing ureter in childhood.
Impact:
- Demonstrates the benign, self-resolving nature of ureteral membranes in children.
- Suggests that ureteral membranes do not necessitate urologic intervention.
- Highlights the low risk of long-term renal compromise despite potential association with UTIs.
Abstract:
Over a period of thirteen years in 28 children (age 4 weeks to 11 years) mucosal membranes of the proximal ureter were diagnosed by intravenous urography. In 61% of all cases the anomalies were demonstrated within the first year of life. Predominantly boys were affected (75%). Most of the associated anomalies (n = 15) were related to the urogenital system (n = 7). The membranes were bilateral in 12 cases and either separate (n = 15) or multiple (n = 25), resulting in a cork-screw-like structure. Minor signs of obstruction of the corresponding renal pelvis were found in 45%, independent of the number of membranes. Urinary tract infection (UTI) occurred in half of all cases. Kidney length was not reduced in any child. The mean serum creatinin (SCR) level was 0.6 +/- 0.4 mg/dl. Surgical correction was never performed. The clinical follow-up investigation (n = 14) after a mean period of 5.1 (1-14) years revealed recurrent UTI in only 2 patients. The mean SCR level remained normal (0.5 +/- 0.3 mg/dl). The tendency of involution of the membranes, supposed by the clinically benign course, is demonstrated to serve as an example. Although a predisposing effect to UTI cannot be excluded, ureteral membranes must be regarded as harmless and transitory anomalies of the growing ureter in childhood which do not require urologic intervention.