Management of the Primary Obstructed Megaureter (POM) and Indication for Operative Treatment

Stehr, Maximilian; Metzger, Ralf; Schuster, Tobias; Porn, Ute; Dietz, Hans–Georg

doi:10.1055/s-2002-25088

Cited by 43 publications

(21 citation statements)

References 8 publications

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“…Tc-MAG3 with furosemide (10,31). This estimate of absolute renal function has been used to differentiate obstructive dilatations with implications for the renal parenchyma from those without.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Primary obstructed megaureter (POM) in children

Nagy¹,

Baca²,

Böör³

2013

BLL

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“…Although diuresis renogram is widely regarded as the most useful tool for assessing the degree of obstruction, there is little exact data [6,15,25] and the prognosis of intermediate obstruction (O'Reilly type D) is unclear. We found a very similar risk of later deterioration and surgery, as well as of spontaneous regression, in patients with initially intermediate obstruction and those with relevant obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical therapy was performed in most cases. With modern ultrasound techniques, about 40% of POMs are discovered prenatally [6] and the fraction of symptomatic children decreased to 22-50% [7,8]. In the 1990s, several reports documented the high rate of spontaneous regression of prenatally diagnosed POM [7,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Complications and long-term outcome of primary obstructive megaureter in childhood

et al. 2010

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We assessed the clinical outcome of 49 children with 56 primary obstructive megaureters (POM) treated with the primarily conservative approach recommended by the 2001 German consensus guidelines. POM occurred more often in boys (71%) and on the left side (67%). Forty-three POM (77%) were treated conservatively. Four kidneys underwent immediate surgery and nine of 52 kidneys managed primarily conservatively worsened subsequently, requiring surgery. Urinary tract infections (UTI) were the most common complication (mean 1.3 per patient), with frequent hospital admission (45%). During the first year of life, the incidence of UTIs was 55% less during prophylactic antibiotic treatment (0.94 vs.0.42 UTIs per year, p < 0.05). Spontaneous regression occurred in 80% of POMs with dilated non-obstructive renogram, but in <20% with intermediate or relevant obstruction. All megaureters with <8.5 mm sonographic diameter regressed, but none over 15 mm. Eight patients had a poor outcome (partial kidney function <40% (n = 6), renal atrophy (n = 3)), but in seven of the patients, these findings were already present postnatally. In summary, the long-term outcome of POM appears favorable with mainly conservative treatment. UTI as the most common complication was 55% lower with antibiotic prophylaxis in infants. Adverse outcome was more closely related to congenital kidney hypoplasia than to degree of obstruction.

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“…According to today's knowledge that a high percentage of the primary obstructive megaureters normalizes without impairment of renal function, the conservative approach is justified in severe asymptomatic cases too [1,3,15,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…A spontaneous improvement rate of 43% to 100 % (median 90) of the unoperated patients was registered. In studies which refer exclusively to asymptomatic pre-and/ or directly post-natally diagnosed megaureters, the rate of the children operated on is only between 0 and 28% [3,8,[19][20][21]. A long-time follow-up revealed that the performance of the kidneys with a primary megaureter produced the expected growth during the organ maturation in case of conservative treatment [5].…”

Section: Discussionmentioning

confidence: 99%