[Surgical treatment of primary mega-ureter]

Primary megaureter is a congenital dilatation of the ureter secondary to obstruction of its terminal portion. It must be corrected surgically only when its obstructive nature can be demonstrated and/or in the presence of complications (especially when it is associated with vesicoureteric reflux). Surgical treatment must always include resection of the obstructive part and ureterovesical reimplantation with an anti-reflux device. Compliance with these 2 principles may require remodelling of the ureter depending on the size of the urethra and bladder. Many surgical procedures can be performed, but 3 procedures are proposed allowing the management of the great majority of situations: 1. Transtrigonal reimplantation according to Cohen without remodelling of the ureter, when the ureteric calibre is less than 1 cm. 2. Transtrigonal reimplantation according to Cohen with remodelling of the transmural portion of the ureter. 3. Suprahiatal reimplantation with extravesical remodelling of the ureter according to Hendren in the case of dolichomegaureter. The other ureteric remodelling or plication techniques are indicated more rarely.