Resolution of primary non-refluxing megaureter: An observational study

Abstract

AimA prospective review of conservative management of primary non-refluxing megaureters (PM) was performed to determine the time taken for resolution (TTR) and complications. Material and MethodsPatient details were obtained from a prospectively maintained database from January 1, 2003, to December 31, 2011. The clinical features of USS and MAG3 findings were analyzed. All had annual USS and MAG 3 scans two yearly (and whenever necessary). ResultsFifty ureteric units (UU) in forty-four patients (six bilateral) were studied. There were thirty-three (75%) males. In the unilateral PM, 22/38 were left-sided. Children were classified according to the lower ureteric diameter (UD) into two groups: Group A (Gp A) UD <10mm (n=25, 26 UU), and Group B (Gp B) UD ≥10mm (n=19, 24 UU). Antenatal diagnosis was achieved in 21 (84%) UU in Gp A and 11 UU (58%) in Gp B.In Grp A, the median presenting UD was 6 (range 4–9)mm, and 76% resolved completely over a median duration of 60 (18–204)months. In Grp B, the median UD was 15 (10–27)mm, and 17% resolved completely over a median duration of 102 (42–210)months. Two developed ureteric calculi (removed ureteroscopically). Three with complications (obstructive drainage pattern in MAG 3 with decreasing function and debilitating infections) underwent ureteric tapering and reimplantation. An obstructed megaureter resolved after endoscopic dilatation. Another underwent temporary ureterostomy on developing hypertension. ConclusionThe exclusively conservative management of PM seems highly successful within Group A (i.e. UD <10mm). Complications (stones, decreasing renal function) were more common with higher UD. TTR seems to take over five years in both groups.