Purpose: The present study aimed to investigate the efficacy of endoureterotomy in patients who were less than 1-year-old with primary obstructive megaureter (POMU).
Patients and Methods: Three of 10 patients with POMU aged between 2 and 12 months for whom conservative management was not applicable had recurrent urinary tract infection (UTI) and urosepsis, while the rest had decreased renal function. After obtaining the clinical history and performing physical examinations and imaging studies (ultrasonography, voiding cystourethrography (VCUG), radionuclide renal scan), the patients underwent endoureterotomy using a neonatal ureteroscope (4.5F) and Bugbee electrode with pure cutting current at the 6 o'clock position. A Double-J stent was inserted and removed 1 week later. This was followed by serial physical examination, renal function test, urine analysis, urine culture, and imaging studies in the 1st month and every 3 months after Double-J stent removal.
Results: Hydroureteronephrosis was significantly decreased in nine patients. Postoperative VCUG revealed no sign of iatrogenic vesicoureteral reflux. In addition, a follow-up renal scan showed remarkable improvement in the renal function in the patients who had decreased renal function, except for one patient in whom uncontrolled urosepsis developed in the follow-up; the patient underwent cutaneous ureterostomy. No UTI was detected in the group who presented with recurrent UTI and urosepsis.
Conclusion: According to the results of our study, endoureterotomy may be an alternative in management of POMU. Of course, further studies with longer follow-up periods are needed to confirm the applicability of this method in patients younger than 1 year.
Written by:
Shirazi M, Natami M, Hekmati P, Farsiani M. Are you the author?
Department of Urology, Shiraz Medical School, Shiraz, Fars, Iran.
Reference: J Endourol. 2013 Oct 17. Epub ahead of print.
doi: 10.1089/end.2013.0098
PubMed Abstract
PMID: 23937376
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