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Megaureter

Dilated ureter > 7 mm diameter.

Often detected antenatally.

Important to determine if obstructed, refluxing, both or neither.

3 broad categories:

 

  1. Obstructed megaureter

Usually due to intrinsic, primary obstruction or stenosis at the distal ureter/VUJ – “VUJ obstruction”.

Can also be due to an aperistaltic segment near bladder.

Markedly dilated ureter proximally to a “normal” or thinned segment at VUJ typical finding.

Need to exclude reflux with MCUG, and PUV in boys first.

 

Indications for treatment:

  • Poorly functioning kidney < 35 – 40 % on renogram
  • Recurrent UTIs or other symptoms

Treatment = ureteric reimplantation (Cohen cross-trigonal or Politano-Leadbetter) – preferably after 1st birthday at least. May need to plicate or taper ureter. Bilateral cases may think about reimplant/hitch one side with TUU.

Can be temporised with a ureteric stent.

 

  1. Non-refluxing, non-obstructed megaureter

Dilated but not obstructed. Often unclear aetiology – ?VUJ obstruction which has resolved, but with ongoing stretched, dilated ureter.

Surveil – may occasionally need treatment if recurrent UTIs etc.

 

  1. Refluxing megaureter

Treat as per reflux.