[Therapeutic mega-ureter primitive before one year of life, retrospective study of 20years].
BACKGROUND
What is the proper way to manage complicated primary mega-ureter in infants under the age of one. This has already been discussed in the literature but the controversy remains.


OBJECTIVE
Evaluate the long-term results of the management of mega-ureter based support under the age of one.


METHODS
Single-center retrospective study from 1990 to 2010. All children under one year found were evaluated including clinical examination, ultrasound, scintigraphy and cystography. They were divided into two groups: group 1: children operated on before the age of one year, group 2 non-operated or operated children after the age of one year. We analyzed the long-term evolution of these children on the following criteria: reflux, pyelonephritis, changes in dilation, renal function, need for surgical revision or secondary surgery, and impact on bladder function.


RESULTS
In total, 54 patients were included in group 1 and 56 patients in group 2. In a median follow-up of 12 years. A total of 101 boys and 9 girls (sex-ratio 11.22). There were 57 left MUP (52%), 22 right (20%) and 31 bilateral (28%). A total of 71% of antenatal diagnosis. No difference on the emergence of complications: 25 (group 1) versus 31 (group 2) OR=0.69; 95% (0.307; 1.574); P=0.44. No difference between secondary surgery and revision surgery: group 1=12, group 2=22, OR=0.45; 95% CI (0.17, 1.09); P=0.06. No difference for daytime incontinence: OR=1.04; 95% CI (0.14; 7.64); P=0.67. Seventy-six children (69%) were finally made, 12 children operated twice (10.9%) and 34 children (31%) never made.


CONCLUSIONS
The main challenge of the MUP of management is the preservation of renal function. Sixty-nine percent of our children received surgery due to impaired renal function lower than 30% of urethral dilatation greater than 10mm associated with reflux or recurrent pyelonephritis. Clinical monitoring, regular ultrasound and isotopic testing are necessary and should be extended to adulthood.


METHODS
5.
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France. Electronic address: baptiste.picart@hotmail.fr.
B
B
Picart
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
M
M
Pons
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
A
A
Line
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
C
C
François
Service de chirurgie pédiatrique, American Memorial Hospital, CHU Reims, 47, rue Cognacq-Jay, 51100 Reims, France.
M-L
ML
Poli Merol
D004108:Dilatation, Pathologic / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014513:Ureter / Q000473:pathology*; D014515:Ureteral Diseases / Q000628:therapy*
Bladder dysfunction; Child; Chirurgie; Cohen; Cohen technique; Dilatation; Dysfonction vésicale; Enfant; Evolution; Mega-ureter; Méga-uretère; Nourrisson; Reflux; Réimplantation; Stretching; Surgery; Technique; Évolution