Primary Non-refluxing Megaureter: Analysis of Risk Factors for Spontaneous Resolution and Surgical Intervention

Abstract

Background: The risk of febrile urinary tract infection (fUTI) in children with primary non-refluxing megaureter (PM) has been extensively studied in the literature, however, a paucity of information exists regarding risk factors for surgical intervention and spontaneous resolution. We sought to analyze data from our prospectively collected PM cohort to determine risk factors that would predict surgery and resolution in this population. Methods: Patients with PM were identified from our prospectively-collected prenatal hydronephrosis (HN) database from 2008 to 2017. Primary outcomes included surgical intervention and hydroureter resolution. Spontaneous resolution was defined as ureteral dilation <7 mm at last follow-up. Age at presentation, gender, development of fUTI, HN grade [low (SFU I/II) vs. high (SFU III/IV)], anteroposterior diameter (APD) measurements and ureteral diameter at baseline and last follow-up were recorded. Univariate and multivariable analyses (binary logistic and Cox regression) were performed. Results: Of 101 patients, 86 (85%) were male, and 80 (79%) had high grade HN. Median age at baseline and last follow-up were 2 (0–23) and 29 (2–107) months, respectively. Overall, 23 (23%) patients underwent surgery at a median age of 22 (3–35) months. Mean ureteral diameter was larger in surgical patients vs. those treated non-surgically (14 ± 4 vs.11 ± 3 mm; p < 0.01). Of the 78 (77%) non-surgical patients, 43(55%) showed resolution of their ureteral dilation at a median age of 24(4–56) months. Survival analysis demonstrated that 12 patients resolved by year 1, 22 by year 2, 30 by year 3, 40 by year 4, and 43 by year 5. However, when considering resolution as APD <10 mm, 62(79%) children resolved their HN by last follow-up (29 months). Univariate and multivariable analyses ( Table 1 ) revealed that high-grade HN at baseline, development of fUTI, and ureteric dilation ≥14 mm were significant risk factors for surgical intervention. Cox regression ( Figure 2 ) found that ureteral dilation <11 mm was the only independent risk factor significantly associated with PM resolution ( Table 2 ). Conclusion: Patients with PM and high-grade HN, as well as individuals with ureteral dilation ≥14 mm and fUTI were more likely to undergo surgical intervention. Ureteral dilation <11 mm was the only independent risk factor significantly associated with spontaneous resolution of PM.

Does Renal Function Remain Stable after Puberty in Children who underwent Ureteral Reimplantation due to Ureterovesical Junction Obstruction?

“…Dekirmendjian and Braga followed-up 101 infants with primary non refluxing megaureter, 23 of them needed surgical intervention. 7 In their study, the two independent variables significantly associated with a need in surgical intervention such as febrile urinary tract infections and ureteral dilation !14 mm. They did show the renal function before the surgery, but have had no data available during follow-up.…”

“…[1][2][3][4][5][6] The percentage of children in need of surgery ranges from 23 to 30% in various articles in the literature. [7][8][9][10] We have previously published that risk factors, which might require surgical correction were Society for Fetal Urology (SFU) grades 3 and 4 of postnatal hydronephrosis, relative renal function less than 30%, and ureteral diameter more than 1.33 cm. 10 The good short-and midterm results after ureter reimplantation with regard to the improvement or preservation of renal function are well described before, even in poorly Introduction Ureteric reimplantation due to ureterovesical junction (UVJ) obstruction enjoys high success in the short term.…”

Febrile Urinary Tract Infections in Children with Primary Non-Refluxing Megaureter: A Systematic Review and Meta-Analysis

“…All studies including children (1) less than 18 years of age with PM (with or without concomitant pelvi-calyceal dilatation), (2) diagnosed postnatally by renal ultrasound (US) or any other appropriate cross-sectional imaging method at the age of 7 days or older, 8,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]6). Aus diesen Daten kann vermutet werden, dass eine antibiotische Dauerprophylaxe über einen Zeitraum von 1-2 Jahren 4,3 Kindern gegeben werden muss um 1 fieberhafte Harnwegsinfektion vermeiden zu können.…”

“…The prevalence of fUTI separated for gender was available in two studies; with a prevalence of fUTI in males of 25.6 % (n = 86) and 0 % (n = 16) versus 13.3 % (n = 15) and 20 % (n = 5) in female patients [18,53].…”

Risk of urinary tract infection in patients with hydroureter: An analysis from the Society of Fetal Urology Prenatal Hydronephrosis Registry

“…Currently, nearly 79% of patients with hydroureteronephrosis present on perinatal ultrasound while the minority of patients present after a febrile urinary tract infection (UTI) [2]. Most patients with ureteral dilation will resolve spontaneously on postnatal follow-up and can be managed conservatively [3,4].…”