Management of Primary
Obstructive Megaureter without
Reflux in Neonates

Mollard, P; Foray, Philippe; Godoy, Javier; Valignat, C.

doi:10.1159/000474359

Cited by 29 publications

(20 citation statements)

References 8 publications

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“…Rickwood et al (24) confi rmed the reliability of the active observation of patients with prenatally diagnosed megaureter, even in cases in which, according to renographic criteria, this seemed obstructive. We have reached, within groups of our patients treated in both ways -surgically and conservatively, results comparable to published data (3,9,14,19). A conservative treatment was indicated in patients with a lower degree of hydronephrosis and dilatation of ureter.…”

Section: Discussionsupporting

confidence: 88%

“…Another possibility is the implementation of double J-stent -ureteral endoprosthesis (22,32). For minimal invasiveness, ease and safety, however, we gave the priority in children with POM, like other authors, to percutaneous puncture nephrostomy (19,5). Children with nephrostomy, if necessary and after informed consent of parents were without major problems regularly treated on outpatient basis.…”

Section: Discussionmentioning

confidence: 98%

“…Consequently, it was assumed that surgical treatment would re- quire only about 10 % of patients with POM (23). There is no doubt about indication of surgical treatment for this anomaly in POM of high level, in functional kidney damage or complicated UTI (20,28). The management of the treatment of POM is still controversial.…”

Section: Discussionmentioning

confidence: 99%

“…There's consent among urologists, that surgical correction is necessary in case of signifi cant anatomical obstruction of POM, which is defi ned as a obstructive uropathy when the kidney exhibited stasis and large pelvic and caliceal dilatation (19,26). On the other hand, when the kidney was subnormal or slightly dilated on urography (IVP), the patients were not operated on in the hope of a spontaneous improvement of the megaureter (19). However, there is also information concerning successful nonoperative treatment followed by spontaneous remission of this congenital anomaly.…”

Section: Discussionmentioning

confidence: 99%

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Primary obstructed megaureter (POM) in children

Nagy¹,

Baca²,

Böör³

2013

BLL

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Abstract:The aim of this study was to analyze the results of surgical and conservative treatment of non-refl uxing POM. In the period 2000-2009, 45 children (52 ureters) were treated, the average age was 5.8 months (±10.33), 24 children (26 ureters) by surgery (I) and 21 children (26 ureters) by conservative means (II). The average follow-up period was 73.8 (±32.91) and 30.85 months (±23.1) resp. Urine examination, USG, DTPA 99mTc , biochemical testing, micturating cystouretography in all patients were performed. Signifi cant difference was present in the occurrence of hydronephrosis of 0th, 3rd and 4th grade, p<0.01, or p=0.17; next in the occurrence of normal ureter, 0-5 mm and dilated ureter >10 mm, p<0.01; and in the occurrence of normal and prolonged time T ½, p<0.01. The health condition was adjusted in 13 (54.20 %), improved on DTPA 99mTc in 5 (20.85 %), non-improved in 3 (12.50 %), deteriorated in 1 (4.15 %) and unknown in 2 (8.3 %) patients. In the IInd group a signifi cant difference was in case of occurrence of hydronephrosis of 0th, 2nd and 3rd grade, (p<0.01, or p=0.037 and p=0.011) and in occurrence of normal ureter, with ureter 0-5 mm and dilated ureter 5-10 mm, p<0.01. The condition at the end of the follow-up period was assessed DTPA 99mTc as adjusted in 11 (52.39 %) patients, improved in 6 (28.57 %), unimproved in 3 (14.28 %) and no patient was assessed as having deteriorated and unknown in 1 (4.76 %). Conclusion:In patients with an impaired separate kidney function, early surgical treatment helps to minimize damage to the kidney function and prevents future complications (Tab. 6, Fig. 3, Ref. 32). Full Text in PDF www.elis.sk. Key words: primary obstructed megaureter, cystouretography, hydronephrosis, kidney function, normal ureter. This prospective study with systematically examined consecutive patients by a created protocol for both of the groups was aimed to compare surgical and conservative treatment of the primary obstructive megaureter (POM) in selected group of children. We present our view on the issue and the results of treatment in different groups of patients. Materials and methodsIn the Department of Urology in the Louis Pasteur University Hospital in Košice, between the years 2000-2009, we were treating 45 patients (52 ureters) with POM diagnosis. Patients' ages ranged between 1-63 months with the average of 5.8 months (±10.33). The clinical group was divided into the two groups according to the entrance criteria -that is group I -patients who were operated on and group II non-operated patients. We created a protocol for both of the groups on the basis of which we prospectively examined the patients, we were observing them and we evaluated the outcomes of the treatment. Within the methodology, we performed examination of the urine and urinary sediments, bacteriological examination of urine, in order to indicate the degree of dilatation of hydronephrosis and the width of the megaureter by USG of the kidneys and ureter, DTPA 99mTc with the application of furosemide in order to detec...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Primary obstructed megaureter (POM) in children

Nagy¹,

Baca²,

Böör³

2013

BLL

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“…15 of primary megaureter has evolved over the years to an initial conservative approach, because the majority of patients tend not to require surgery, particularly when the condition is diagnosed prenatally. 1,3,16 Our approach to asymptomatic cases also was initial nonoperative management that includes regular clinical and radiographic evaluations as well as antibiotic prophylaxis. Although some studies have shown the safety of conservative management with long-term follow-up, 1-3 in a group of patients with primary nonrefluxing megaureter, the reported failure rate for nonoperative treatment was 84%.…”

Section: Discussionmentioning

confidence: 99%