S Bapat1, M Bapat, D Kirpekar. 1. Maharashtra Medical Foundation, Pune, India. shivadeo@gatewaysys.com
Abstract
BACKGROUND AND PURPOSE: Congenital obstructive megaureter (COMU) may be unilateral or bilateral and may present in later years of life. If the obstruction is not relieved in good time, deleterious effects on the proximal ureter and kidney are well known. Stones may complicate the situation further. So far, the only treatment that has been available is to disconnect the ureter proximal to the site of obstruction, remove any stone, and reimplant the ureter into the bladder after any necessary tailoring. After noticing the encouraging results of endopyelotomy for congenital ureteropelvic junction obstruction, we decided to use the same principle for the management of COMU, as similar functional pathology is present in both situations. PATIENTS AND METHODS: Our technique was applied in six ureters in five adult patients. After cystoscopic evaluation of the bladder and ureteral orifice, a guidewire was advanced up the ureter, and the lower ureter was dilated. A ureteroscope or other suitable endoscopic instrument was passed, and the obstructed segment of the ureter was incised at the 6 o'clock position with pure cutting current. All of the layers of the ureter were incised in the long axis through the entire obstructive segment, so as to expose the periureteral areolar tissue. If necessary, a similar cut was made at the 12 o'clock position. Utmost care was taken not to incise the bladder mucosa. A double-J stent was inserted for 3 weeks. RESULTS: Follow-up for 1 to 4 years showed free drainage of urine into the bladder, with marked reduction in proximal stasis and freedom from recurrent infection and pain. CONCLUSION: Although our series is small and follow- up is relatively short, it appears that endoureterotomy is a safe and effective treatment for COMU.
BACKGROUND AND PURPOSE:Congenital obstructive megaureter (COMU) may be unilateral or bilateral and may present in later years of life. If the obstruction is not relieved in good time, deleterious effects on the proximal ureter and kidney are well known. Stones may complicate the situation further. So far, the only treatment that has been available is to disconnect the ureter proximal to the site of obstruction, remove any stone, and reimplant the ureter into the bladder after any necessary tailoring. After noticing the encouraging results of endopyelotomy for congenital ureteropelvic junction obstruction, we decided to use the same principle for the management of COMU, as similar functional pathology is present in both situations. PATIENTS AND METHODS: Our technique was applied in six ureters in five adult patients. After cystoscopic evaluation of the bladder and ureteral orifice, a guidewire was advanced up the ureter, and the lower ureter was dilated. A ureteroscope or other suitable endoscopic instrument was passed, and the obstructed segment of the ureter was incised at the 6 o'clock position with pure cutting current. All of the layers of the ureter were incised in the long axis through the entire obstructive segment, so as to expose the periureteral areolar tissue. If necessary, a similar cut was made at the 12 o'clock position. Utmost care was taken not to incise the bladder mucosa. A double-J stent was inserted for 3 weeks. RESULTS: Follow-up for 1 to 4 years showed free drainage of urine into the bladder, with marked reduction in proximal stasis and freedom from recurrent infection and pain. CONCLUSION: Although our series is small and follow- up is relatively short, it appears that endoureterotomy is a safe and effective treatment for COMU.