title: Conservative management of primary non-refluxing megaureter during the first year of life: A longitudinal observational study.
abstract: BACKGROUND
  There is a lack of prospective studies that include a selected population of patients with primary non-refluxing megaureter (PM). Thus, a longitudinal observational study was designed to follow from birth a selected population of children with PM; all were antenatally diagnosed. In this paper, the outcomes observed in the first year of life are presented.
  
  
  OBJECTIVE
  The primary aim was to follow the natural history of PM. The secondary aim was to monitor the onset of any potential complications such as urinary tract infections (UTIs), need for hospitalization and need for surgical correction.
  
  
  METHODS
  All children with antenatally diagnosed PM, born between January 2007 and December 2013, were prospectively followed with observational management: renal ultrasonography and clinical evaluation on a 3-month basis; urinalysis and culture in case of symptoms; and mercaptoacetyltriglycine (MAG3) nuclear scan once older than 1 month. Children presenting at birth with mild urinary tract dilatation were included in Group A; those with moderate-to-severe dilatation were included in Group B. Continuous antibiotic prophylaxis (CAP) was administered to Group B.
  
  
  RESULTS
  Forty-seven children (44 males, three females) with 58 PM were included in the study. The participants and their corresponding outcomes are shown in the summary Table. The presence of obstruction at renogram was a significant predictor of UTIs and hospitalization.
  
  
  CONCLUSIONS
  The strengths of this study were its prospective nature and its very consistent population. A limitation was the lack of control groups. The results regarding the negligible incidence of complications in Group A and the residual incidence of febrile UTIs (20%) and hospitalization (17%) in Group B, even with CAP, are in line with previous literature. In contrast, there was a higher risk of UTIs observed in children aged older than 6 months.
  
  
  CONCLUSIONS
  Resolution or improvement is expected in all cases of PM with mild postnatal dilatation, and close to 60% of those with moderate or severe dilatation. Surgery is rarely performed on children younger than 1 year of age. It is safe to observe children with mild urinary tract dilatation without CAP, because the incidence of UTIs is negligible. In those presenting with moderate or severe urinary tract dilatation, despite CAP, a residual incidence of UTIs is seen, and symptomatic patients often require hospitalization. However, UTIs are well tolerated and do not seem to modify outcome. Cases showing obstruction on the MAG3 scan seem to be at higher risk of UTIs and hospitalization.
authors.affiliation: Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti and 'Spirito Santo' Hospital of Pescara, Via Fonte Romana n.8, 65124 Pescara, Italy. Electronic address: dacia.direnzo@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: DiRenzo
authors.affiliation: Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti and 'Spirito Santo' Hospital of Pescara, Via Fonte Romana n.8, 65124 Pescara, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Persico
authors.affiliation: Department of Biomedical Sciences and Statistics, 'G. d'Annunzio' University of Chieti, Via dei Vestini, 66100 Chieti, Italy.
authors.forename: M
authors.initials: M
authors.lastname: DiNicola
authors.affiliation: Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti and 'Spirito Santo' Hospital of Pescara, Via Fonte Romana n.8, 65124 Pescara, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Silvaroli
authors.affiliation: Department of Nuclear Medicine, 'Santissima Annunziata' Hospital of Chieti, Via dei Vestini, 66100 Chieti, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Martino
authors.affiliation: Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti and 'Spirito Santo' Hospital of Pescara, Via Fonte Romana n.8, 65124 Pescara, Italy.
authors.forename: P
authors.initials: P
authors.lastname: LelliChiesa
mesh_terms: D002675:Child, Preschool; D004108:Dilatation, Pathologic; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D014513:Ureter / Q000002:abnormalities*; D014517:Ureteral Obstruction / Q000151:congenital / Q000453:epidemiology / Q000628:therapy*
keywords: Antibiotic prophylaxis; Hydronephrosis; Megaureter; Prenatal diagnosis; Primary non-refluxing megaureter; Urinary tract infection