Megaureter In Adults Research Articles

Megaureter in adults: a review of the current literature.

Megaureter (MU) is an uncommon condition in adults. The aim is to present a review of the current literature. A literature search was conducted to explore the current literature including case reports on MU in adults in the period 2003-2023. Each case was characterised in terms of the eight categories: sex, age, etiology, location, symptoms, diagnostic tool used, type of treatment and follow-up. There was no meta-analysis but two reviews. Total, 39 case reports were included based on 35 articles. The most common observations for the first four categories were male (sex), age below 40 (age), obstructed MU (etiology) and left-sided MU (location). Almost every patient appeared with symptoms, most frequently flank pain, abdominal pain and recurrent urinary tract infections. CT scan and transabdominal ultrasonography are the most commonly used diagnostic tools. Most cases underwent either laparoscopic or open surgical treatment with ureteral reimplantation as the most performed surgical procedure. A majority of the patients had an uneventful follow-up. MU in adults is a rare condition presenting with heterogeneous symptoms. CT scan and transabdominal ultrasonography should be used as diagnostic tools. Nearly all patients underwent surgical treatment with an uneventful follow-up. Complications such as stone formation and altered function of the affected kidney are common. Surgical treatment is recommended and is determined by consideration of age, symptoms, ureteral extension and progressive loss of renal function.

A Rare Case of Hydronephrotic Multicystic Dysplasia with Ipsilateral Upper Segmental Megaureter in Adults

Multicystic dysplasia in adults is a rare entity. It may present as a mass, with pain, or be detected incidentally on imaging. Here, we present a case of hydronephrotic multicystic dysplasia with ipsilateral upper segmental megaureter in an adult female patient. To the best of our knowledge, this is the first such case described in the English literature.

Primary obstructive megaureter in adults: need for an aggressive management strategy.

Primary obstructive megaureter (POM) is an uncommon disease in adults. We reviewed our experience with this disease to determine the clinical profile, management and prognosis of this disease in adults. We studied 37 adults with POM who presented from January 1989 to December 1998. Their clinical presentation, renal function, radiologic data, complications, treatment as well as the results and follow-up were studied. The patients' age ranged from 13 to 52 years. Male:female ratio was 27:10. Seven patients had bilateral disease. All patients were symptomatic excepting 2. Complications at presentation were loin pain (26 cases), urinary infection (15 cases), calculus disease (17 cases), azotaemia (5 cases), and obstructive jaundice (1 case). Associated congenital anomalies included contralateral renal agenesis (2 cases), posterior urethral valve (1 case) and exstrophy of bladder (1 case). Thirty-four patients required surgical intervention. Of these, 26 patients underwent ureteroneocystostomy (UNC) with ureteral tailoring in 18 patients; 4 patients were treated endoscopically by ureteric meatotomy and stenting, 2 patients with nonfunctioning kidney by nephroureterectomy, 2 patients in advanced renal failure by percutaneous nephrostomy alone. In 4 out of 5 patients uraemia did not improve despite adequate drainage. The majority of adults with POM are symptomatic, have complications and require surgical correction. Complications of stone formation (46%) and renal failure (13.5%) are unusually common in adults. Once renal failure is advanced, intervention appears futile, therefore, it is imperative to treat these patients as soon as possible. Surgical correction by ureteric re-implantation is effective and has low morbidity.

Primary non-obstructive megaureter in adults

Primary non-obstructive megaureter is rarely first diagnosed in adult life. The clinical and radiographic findings in 11 adults presenting with this condition are reviewed. The commonest complaint was pain. In all cases the diagnosis was suggested by intravenous urography, which was usually the initial diagnostic test. Confirmation was aided chiefly by micturating cystography and retrograde pyelography. Cystoscopy was normal. The radiologist can make an early diagnosis in this condition, which requires no treatment, in the absence of complications.

Primary Megaureter in Adults

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. Primary obstructed megaureters must be clearly differentiated from megaureters caused by infravesical obstruction. The characterization and therapeutical consequences of the two types also differ. In a retrospective study, 43 adult patients with 54 primary obstructed megaureters (male:female = 30:13) were studied. This diagnosis excluded infravesical obstruction, reflux and neurogenic disorders. The main symptoms were flank pain, infection and hematuria. An operation was performed in 25 patients; 29 were treated conservatively. The criteria for surgery are discussed in relation to symptoms, functional reserves of the kidney, transportation capacity of the upper urinary tract, and histological changes of the narrow segment of the ureter. Operative treatment should be limited to well-defined complications, such as deterioration of kidney function or recurrent infection, to avoid its discredit as merely a cosmetic procedure.

Primary megaureter in adults.

The terminology of megaureters, their histological findings and etiology vary greatly in the literature. Primary obstructed megaureters must be clearly differentiated from megaureters caused by infravesical obstruction. The characterization and therapeutical consequences of the two types also differ. In a retrospective study, 43 adult patients with 54 primary obstructed megaureters (male:female = 30:13) were studied. This diagnosis excluded infravesical obstruction, reflux and neurogenic disorders. The main symptoms were flank pain, infection and hematuria. An operation was performed in 25 patients; 29 were treated conservatively. The criteria for surgery are discussed in relation to symptoms, functional reserves of the kidney, transportation capacity of the upper urinary tract, and histological changes of the narrow segment of the ureter. Operative treatment should be limited to well-defined complications, such as deterioration of kidney function or recurrent infection, to avoid its discredit as merely a cosmetic procedure.

Primary Obstructive Megaureter in Adults

The clinical features, diagnosis and treatment of 26 adults with primary obstructive megaureter have been reviewed. The histological features and the urodynamics of this disease are discussed. The clinical picture of primary obstructive megaureter in the adult may be deceivingly unimpressive. In this series 2 kidneys were destroyed because of progressive disease in the absence of clinical symptoms. We support Creevy's findings that the pathology involved is an obstructive segment of the ureter on the basis of a thickened muscularis and mild inflammation of the mucosa and submucosa. Urodynamic studies performed by one of us (M.K.H.) suggest that these ureters may remain in a balanced state indefinitely, owing to a low resting pressure. However, there may be relatively little reserve capacity and, with increased urine production rates, the pressure transmitted to the renal collecting system may produce renal atrophy. The radiologic features of the disease may reflect its clinical course, that is those showing a bulb and tail have a more benign course than ureters with a sharp cutoff. High dosage cine-pyelography is valuable in confirming the diagnosis and in studying the contractility of the ureter. Initially, we treated these cases conservatively. The presence of calculi and planned pregnancy are strong indication for surgical interference. Of the 26 patients 15 ultimatley required an operation. We recommend ureteral remodeling and reimplantation whenever possible since 11 of our cases had a most gratifying result from this procedure.

Primary obstructive megaureter in adults: M. R. Heal. Br. J. Urol. 45:490–496, (October), 1973

Primary obstructive megaureter in adults: M. R. Heal. Br. J. Urol. 45:490–496, (October), 1973

Primary obstructive megaureter in adults.

Summary Primary obstructive megaureter usually presents in the adult as an incidental finding during unrinary tract investivagation, or with vaque abdomial pain. The condition is usually statie, but if required, reconstruction and reimplantation gives satisfactory results. Haematuria should be regarded with suspicion as malignant change may occur in the middle third of the ureter.