title: Management of the primary obstructed megaureter (POM) and indication for operative treatment.
abstract: Presented is the diagnostic and therapeutic management of the primary obstructed megaureter (POM). 42 patients presented with 53 ureteral units (UU) of POM (5 females, 37 males, 36 neonates and 6 children aged 3 to 8 years). Of the 53 megaureters 10 UU (19%) were on the right and 27 UU(51 %)were on the left. 8 patients (19%)with 16 UU (30%)showed a bilateral abnormality. In 41% of the patients, hydronephrosis had been discovered by prenatal ultrasound. All patients were evaluated postnatally by ultrasound (US), voiding cysturethrogram (VCUG), intravenous pyelogram (IVP) and diuresis renogram (MAG-3) (DR). Due to the percentage of urinary drainage,the renogram results were classified into different categories:no obstruction, functional obstruction, equivocal and obstruction. A partial renal function was also calculated. Follow-up of the patients ranges between 5 to 48 months (mean: 22.1). All patients underwent serial US and serial DR were obtained in 36 patients. Initially, 9 (17%) UU showed a functional obstruction, 34 (64.2%) an equivocal and 10 (18.8%) an obstructive urinary drainage pattern. 2 kidneys showed a significant decreased partial function of 20, respectively 26%. Surgery was performed in an initial im-paired renal function with an obstructive pattern or in cases with normal function and at least equivocal urinary drainage pattern with no improvement or deterioration of the urinary drainage and/or function in the follow-up. Considering these criteria, 5(9.6%) patients needed surgery. No loss of kidney function has been observed in follow-up. DR is the most valuable diagnostic tool. Criteria interpreting the results are demonstrated in this article.
authors.affiliation: Kinderchirurgische Klinik im Dr. v. Haunerschen Kinderspital, Munich, Germany. STEHR@HUB.tch.harvard.edu
authors.forename: M
authors.initials: M
authors.lastname: Stehr
authors.forename: R
authors.initials: R
authors.lastname: Metzger
authors.forename: T
authors.initials: T
authors.lastname: Schuster
authors.forename: U
authors.initials: U
authors.lastname: Porn
authors.forename: H-G
authors.initials: HG
authors.lastname: Dietz
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011866:Radioisotope Renography; D014463:Ultrasonography; D014513:Ureter / Q000601:surgery; D014517:Ureteral Obstruction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*