Ravibindu Ranawaka1, Supul Hennayake. 1. Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK. rravibindu@yahoo.com
Abstract
AIM: A 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 METHODS: Patient 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). RESULTS: Fifty 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 < 10 mm (n=25, 26 UU), and Group B (Gp B) UD ≥ 10 mm (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. CONCLUSION: The exclusively conservative management of PM seems highly successful within Group A (i.e. UD <10 mm). Complications (stones, decreasing renal function) were more common with higher UD. TTR seems to take over five years in both groups.
AIM: A 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 METHODS:Patient 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). RESULTS: Fifty 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 < 10 mm (n=25, 26 UU), and Group B (Gp B) UD ≥ 10 mm (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. CONCLUSION: The exclusively conservative management of PM seems highly successful within Group A (i.e. UD <10 mm). Complications (stones, decreasing renal function) were more common with higher UD. TTR seems to take over five years in both groups.