THE DILATED URETER - OU Medicine

FIGURE 2
Management of primary megaureter
tion. 13 Predictors for the need for surgical management
include severe or worsening hydronephrosis, ureteral
dilation greater than 1 cm in diameter, and worsening
renal function. 10
While aggressive surgical management is usually
recommended for adults with primary obstructed
megaureter, parents of children with the condition
should be reassured that it is likely to resolve spontaneously.
However, surgical management, when indicated,
is usually successful.
CU
REFERENCES
Improvement or
no change
Perform serial US
imaging
Resolution of
obstruction
No further
imaging
1. King LR. Megaloureter: definition, diagnosis and management. J Urol.
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2. Hemal AK, Ansari MS, Doddamani D, et al. Symptomatic and complicated
adult and adolescent primary obstructive megaureter—indications for surgery:
analysis, outcome, and follow-up. Urology. 2003;61(4):703-707.
3. Dunnick NR, McCallum RW, Sandler CM. Textbook of Uroradiology. 1st
ed. Baltimore, Md: Williams & Wilkins; 1991.
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relationship to the megaureter megacystis syndrome and Hirschsprung’s disease.
J Clin Pathol. 1963;16:342-350.
US, VCUG, and DTPA diuresis renography
Primary megaureter
Low- to mid-grade ureteral
obstruction
Worsening renal
function
Increased dilation
DTPA diuresis
renography
Infection or pain
High-grade ureteral
obstruction
Surgical repair
Decreased function
(>10%) or increased
obstruction
5. Pfister RC, Hendren WH. Primary megaureter in children and adults. Clinical
and pathophysiologic features of 150 ureters. Urology. 1978;12(2):
160-176.
6. Manzoni C. Megaureter. Rays. 2002;27(2):83-85.
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of primary obstructive megaureter. J Urol. 1989;142(2 pt 2):636-640.
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by ultrasonography after 28 weeks’ gestation: incidence and outcome.
Am J Obstet Gynecol. 1995;172(2 pt 1):479-486.
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term followup. J Urol. 1994;152(2 pt 2):618-621.
10. McLellan DL, Retik AB, Bauer SB, et al. Rate and predictors of spontaneous
resolution of prenatally diagnosed primary nonrefluxing megaureter.
J Urol. 2002;168(5):2177-2180.
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and management. Pediatr Med Chir. 2000;22(1):15-24.
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megaureter (POM) and indications for operative treatment. Eur J Pediatr
Surg. 2002;12(1):32-37.
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of prenatally diagnosed primary megaureters. J Urol. 1994;152(2 pt 2):614-
617.
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technique of ureteroneocystostomy (Cohen reimplant) and a modification
for difficult case (experience with 121 ureters). J Urol. 1985; 134(2):
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