Three variants of megaureter
- Obstructive - in the lowest part of the ureter there is a narrow segment devoid of normal peristalsis; urine passes with difficulty, and above it the ureter dilates
- Refluxing - the mouth of the ureter is incompetent, urine from the bladder is thrown back and stretches the ureter
- Non-refluxing non-obstructive - there is dilation, but there is no obstruction or reflux; most common and most favorable option, usually decreases with age
- Mixed forms - a combination of obstruction and reflux
- Secondary megaureter is a consequence of high pressure in the bladder: with a neurogenic bladder, posterior urethral valves, prostate adenoma in adults
Практический смысл этой классификации прямой: необструктивный нерефлюксирующий вариант чаще всего требует только наблюдения, рефлюксирующий ведут как рефлюкс, обструктивный при ухудшении функции почки — оперируют, а вторичный лечат в первую очередь устранением причины высокого давления в пузыре.
Symptoms
- Often detected in utero or on ultrasound in the first months of life without any complaints
- Recurrent urinary tract infections
- Episodes of high fever without catarrhal symptoms
- Abdominal and lower back pain
- Poor weight gain, lethargy, spitting up in babies
- Cloudy urine
- In adults - dull pain in the side, recurring pyelonephritis, stone formation
- With bilateral damage - signs of decreased renal function
Diagnostics
- Ultrasound of the kidneys and ureters - measuring the diameter of the ureter, the thickness of the parenchyma, assessing the dynamics
- Victory cystourethrography is mandatory to distinguish the refluxing variant from the rest
- Dynamic nephroscintigraphy - assessment of kidney function and the presence of true obstruction; key research
- CT or MR urography for complex anatomy
- Urodynamic study for suspected neurogenic bladder
- General analysis and urine culture
- Creatinine and GFR calculation
- In adult men - prostate assessment and uroflowmetry
The key question of the examination is not “how dilated is the ureter,” but “is there an obstruction to the outflow and is kidney function affected?” A wide but well-emptying ureter with intact function is a reason to observe rather than operate.
Treatment
- Observation with regular ultrasound and infection prevention is the main tactic for non-obstructive non-refluxing variant in children
- Antibacterial prophylaxis as prescribed by a doctor in the first months of life and for recurrent infections
- Treatment of reflux with refluxing variant
- Elimination of the cause of high pressure in the bladder with secondary megaureter: posterior urethral valves, neurogenic dysfunction, prostate adenoma
- Ureteral stenting - temporary restoration of outflow
- Percutaneous nephrostomy for acute outflow obstruction and infection
- Ureterocystoneoanastomosis with modeling of the ureter is the main operation for obstructive variant with deterioration of function; performed openly or laparoscopically
- Endoscopic expansion of a narrowed segment with installation of a stent - in some cases
Forecast and observation
- In a significant proportion of children, the dilation of the ureter decreases independently during the first years of life.
- Observation includes ultrasound with assessment of the diameter of the ureter and the thickness of the renal parenchyma
- Scintigraphy is repeated if the ultrasound picture worsens
- Every episode of fever in a child with megaureter requires a urine test
- Monitoring creatinine and blood pressure
- After the operation, observation continues for several years - the expansion decreases gradually, and not immediately
Родителям важно знать: сохраняющееся расширение мочеточника на УЗИ после успешной операции — обычное явление. Эффективность оценивают по функции почки и данным сцинтиграфии, а не по цифрам диаметра.
Where they are examined and treated in Tashkent
We need high-quality dynamic ultrasound, cystography, assessment of renal function and, if indicated, reconstructive surgery on the ureter.
In Tashkent, such examination and surgical treatment of megaureter is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If ureteral enlargement is detected in a child in utero or in the first months of life, do not rush to conclusions: most of these children do not require surgery, but regular monitoring is mandatory. Clinic contacts are below.
