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Primary, non-refluxing Megaureters - A Single Center Experience over two Decades in 212 Children
Raimund Stein, MD1, Julia Hermann, MD2, Peter Rubenwolf, MD1, Rolf Beetz, MD2.
1Division of Pediatric Urology, Mainz, Germany, 2Division of Pediatric Nephrology, Mainz, Germany.
There is ongoing debate as to the most appropriate management of children diagnosed with congenital megaureters. The aim of the present study was to assess the outcome of children with primary non-refluxing megaureter diagnosed and treated at our institution between 1/1986 and 6/2009.
A total of 212 patients (164 boys, 48 girls) with 254 non-refluxing megaureters (ureteric diameter≥6 mm, no associated UT anomalies) were included in the present study. The charts of all patients were retrospectively reviewed with regard to presentation at diagnosis, treatment modalities, clinical course following conservative and/or surgical therapy, complications and latest follow-up. The study was approved by the local ethic committee.
The average follow-up was 3.8 years (range: 0-16). 162/254 megaureters were on the left side. 168 children (79%) were diagnosed ante- or postnatally by ultrasound-screening. 30 patients (14%) initially presented with a symptomatic urinary tract infection.
In the long-term, 191 (75%) megaureters were managed conservatively without intervention. 33 mergaureters (13%) required a temporary high urinary diversion due to urosepsis/pyonephrosis. In 14/33 megaureters, the percutaneous nephrostomy could be removed later on without need of further intervention. In a total of 46 megaureters (18%), a ureterocystoneostomy (UCN) was performed. In 20 megaureters (8 %) UCN was the first line therapy after initial presentation. One non-functioning kidney had to be removed following urosepsis. Whereas a conservative approach was adopted in 54% of the patients between 1986 and 1990, the proportion of conservatively managed patients increased to > 80% since 1996. Urinary tract infections occurred in 43% of all children included in the study. Of note that in the last 5 years only in 25% had UTI. 72% of the children subjected to antibacterial prophylaxis (n=148) had no UTI, as opposed to 22% in patients without antibacterial prophylaxis (n=64).
Our results suggest that more than 80% of children diagnosed with MU can be successfully managed conservatively. Considering our data, antibacterial UTI-prophylaxis seems to be beneficial with the aim of preventing UTIs and infection-associated renal complications.
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