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[Management of primary congenital megaureter with early diagnosis]
1Departamento de Cirugía Pediátrica, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona.
Insights
This study introduces a follow-up protocol for congenital megaureter (CM) diagnosed prenatally. The protocol effectively distinguishes between obstructive and non-obstructive cases, guiding timely surgical intervention for improved outcomes.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging
- Surgical Management
Context:
- Congenital megaureter (CM) is a condition diagnosed prenatally via ultrasound.
- Early diagnosis allows for timely intervention and management.
- Retrospective study of 47 CM cases in 35 infants diagnosed between 1984 and 1993.
Purpose:
- To present and evaluate a follow-up protocol for congenital megaureter (CM).
- To differentiate between obstructive and non-obstructive CM for appropriate treatment selection.
- To assess the efficacy of early surgical intervention based on the protocol.
Summary:
- Diagnosis utilized ultrasound, cystography, intravenous urography (IVU), and isotope tests.
- Obstruction was the primary criterion for early surgery, typically ureter reimplantation with or without tapering.
- 16 CM cases required reimplantation, 7 with tapering; 3 patients had surgery for associated pathology.
- Non-obstructive cases (76.6%) were managed conservatively, with 5 requiring intervention due to infection.
- Post-surgical complications included reflux and uric stone, with favorable overall development.
Impact:
- The protocol aids in selecting congenital megaureter (CM) cases for early surgical intervention.
- It helps identify cases that can be managed conservatively without risk.
- Demonstrates favorable outcomes with appropriate management strategies for CM.
Abstract:
We present our follow-up protocol of congenital megaureter (PCM) diagnosed early thanks to showing prenatal ultrasound the dilatation in the urinary system. 47 PCM were studied retrospectively in 35 babies, out of 240 cases of prenatal renal dilatation, from 1984 to 1993. The final diagnosis was established with the early use of ultrasound, cystography, intravenous urography (IVU) and isotope test. The latter two gave hints as to the existence of obstruction, which was the main criterion for early surgery to be prescribed. The surgical treatment, when it was necessary, consisted of ureter reimplantation (Cohen type), following the resection of the stenotic segment. When it was necessary short distal tapering (3-4 cm) was performed. For the follow-up ultrasound, IVU and isotope test were used. Out of the 35 patients observed, 11 were girls and 24 boys, 9 (25.7%) of the PCM were from the right side, 14 (40%) from the left side and 12 (34.2%) bilateral. 36 PCM (76.6%) were non-obstructive and only follow-up was performed. 5 of them, in 3 patients, had infections and were operated on together with the 11 obstructed PCM. In total, 16 PCM were reimplanted, and associated tapering was need in 7 of them. Other 3 patients were operated on for associated pathology. The post-surgical complications were 2 cases or reflux and 1 uric stone that did not need surgery. The development of all cases was favorable. The protocol has been useful for the selection for early surgical intervention of the subsidiary megaureters from those that can be develop without risk.(ABSTRACT TRUNCATED AT 250 WORDS)