Objectives: The evolution of clinical presentation, age of surgery and therapeutic approach of obstructive nonrefluxing megaureters (OMU) in children throughout the years has been retrospectively evaluated. Methods: 78 children with 92 stenotic ureterovesical junctions (UVJ) were reviewed. 66 underwent surgery at a median age of 20 months, after a median of 10.5 months of conservative treatment with prophylactic antibiotics. 21 OMU were diagnosed prenatally, 71 because of symptoms at later age. 15 ureters (12 children) (24% in the prenatal, 14% in the second group) were treated in a conservative way for 2 years with antibiotics. In the prenatal group 33% needed a reimplantation with tailoring and 10% without tailoring while in the other group the figures are reversed: 39% without and 21% with tailoring. 28% in the prenatal group and 17% of the second group were reimplanted at a mean of 15 months after a primary cutaneous ureterostomy. Three of 5 ureteroceles were treated by endoscopic incision; 4 had an immediate nephroureterectomy. The mean follow-up is >70 months. Results: By prenatal diagnosis the number of conservatively treated cases increased from 14 to 24%. Indications for surgery remained unchanged: recurrent infection and poor kidney function. Both approaches resulted in stabilization of pretreatment renal function; nearly half of the DMSA scans showed a R:L difference of >20% at follow-up. Ureterostomy for infected deteriorating kidneys rapidly ameliorated the function and resulted in shrinking of the ureteral diameter making tailoring at reimplantation unnecessary. One of the 3 endoscopically incised ureteroceles required later reintervention. Conclusions: Male:female (3:1), left:right (2:1) prevalence and high associated urological (30%) and nonurological (19%) pathology is found. Unsatisfactory reliability of tests for obstruction diagnosis and a referral bias explains the larger number of conservatively treated ureters in the prenatal group. Despite prenatal diagnosis, the age for surgery was not altered since the indications remained identical. Most OMU can be treated by a simple or tailored reimplantation of the ureter after resection of the stenotic segment. A temporary ureterostomy in small children with refractory infections restores function and avoids the necessity for tailoring at final reconstruction. One of 3 endoscopically incised ureteroceles needed surgery at a later stage. DMSA shows stable function after reimplantation.

Keywords:
Stenosis of vesicoureteral junction, Obstructive megaureter, Hydronephrosis in children, Temporary ureterostomy
1.
Mollard P, Foray P, De Godoy JL, Valignat C: Management of primary obstructive megaureter in neonates. Eur Urol 1993;24:505–510.
2.
Peters CA, Mandell J, Lebowits RL, Colodny AH, Bauer SB, Hendren WH, Retik AB: Congenital obstructed megaureters in early infancy: Diagnosis and treatment. J Urol 1989;142:641–645.
3.
Avni EF, Pichot E, Schulman CC: Neonatal congenital megaureters: Trends in diagnosis and management. World J Urol 1992;10:90–93.
4.
Keating MA, Escala J, Snyder H, Heyman S, Duckett JW: Changing concepts in management of primary obstructive megaureter. J Urol 1989;142:636–640.
5.
Rudhe U, Ericsson NO: Low ureteric obstruction in infancy and childhood. Ann Radiol 1967;10:247.
6.
Williams DI, Hulme-Moir I: Primary obstructive mega-ureter. Br J Urol 1970;42:140–149.
7.
Mathieu H, Loirat C, Macher MA, Weisgerber G, Guedeney J, Pillion G, Guesnu M: Long-term outcome of children with malformative uropathies. Int J Pediatr Nephrol 1985;6:3–12.
8.
Lockhart JL, Sfakianakis GN, Al-Skeikh W, Stover B, Politano VA: Animal model to study megaureters non-invasively. J Urol 1982;128:633.
9.
Hennebert P, Dardenne B, Rettman R, Cornu G, Claus D: La chirurgie modelante du méga-uretère de l’enfant. Acta Urol Belg 1975;43:313.
10.
Rabinowitz R, Barkin M, Schillinger JF, Jeffs RD, Cook GT: Bilateral orthotopic ureteroceles causing massive ureteral dilatation in children. J Urol 1978;119:839.
11.
Rodriguez JV: Endoscopic surgery of calculi in ureteroceles. Eur Urol 1984;10:36–39.
12.
Tanagho EA: Anatomy and management of ureteroceles. J Urol 1972;107:729.
13.
Nicotina PA, Romeo C, Arena F, Romeo G: Segmental up-regulation of transforming growth factor-β in the pathogenesis of primary megaureter. An immunocytochemical study. Br J Urol 1997;80:946–949.
14.
Weiss RM, Biancani P: Rationale for ureteral tapering. Urology 1982;10:482.
15.
Hendren WM: Operation repair of megaureter in children. J Urol 1969;101:491–507.
16.
Tanagho EA: Ureteral tailoring. J Urol 1971;106:194.
17.
Kalicinski ZH, Kansy J, Kotarbinska B, Joszt W: Surgery of megaureters – Modification of Hendren’s operation. J Pediatr Surg 1977;12:183.
18.
Ehrlich RM: The ureteral folding technique for megaureter surgery. J Urol 1985;134:668.
19.
Bakker HHR, Scholtmeijer RJ, Klopper PJ: Comparison of two different tapering techniques in megaureters. J Urol 1988;140:1237.
20.
Parrott TS, Woodard JR, Wolpert JJ: Ureteral tailoring: A comparison of wedge resection with infolding. J Urol 1990;114:328.
21.
Fowler R, Kesavan P: Extravesical reconstruction for ureterovesical obstructions in childhood. J Urol 1977;118:1050.
22.
Perovic S: Surgical treatment of megaureters using detrusor tunneling extravesical ureteroneocystostomy. J Urol 1994;152:622.
23.
Arap S, Cabral D, Grassano Abrao E, De Campos Freire JG: Traitement chirurgical du méga-uretère. Urol Int 1972;27:205.
24.
Constantini A, Trippitelli A, Carini M, Durval A, Barbagli G, Rizzo M: Uretero-cysto-neostomy by the ‘du pantalon’ technique in the treatment of primary obstructive megaureter. Acta Urol Belg 1986;54:434.
25.
Whitmore KF, Ehrlich RM: Vascular integrity of the distal ureter following combined tapering and cross-trigonal reimplantation. J Urol 1988;139:621.
26.
Rabinowitz R, Barkin M, Schillinger JF, Jeffs RD, Cook GT: Surgical treatment of the massively dilated ureter in children. II. Management by primary reconstruction. J Urol 1977;118:436.
27.
Rabinowitz R, Barkin M, Schillinger JF, Jeffs RD: Surgical treatment of the massively dilated primary megaureter in children. Br J Urol 1979;51:19.
28.
Lee BR, Partin AW, Epstein JI, Quinlan DM, Gosling JA, Gearhart JP: A quantitative histological analysis of the dilated ureter of childhood. J Urol 1992;148:1482.
29.
Mor Y, Ramon J, Raviv G, Hertz M, Goldwasser B, Jonas P: Low loop cutaneous ureterostomy and subsequent reconstruction: 20 years of experience. J Urol 1992;147:1595.
1999
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