Overview
Hydroureteronephrosis, often associated with megaureter, refers to the dilation of the ureter and renal pelvis due to impaired urine flow, frequently resulting from congenital anomalies or mechanical obstructions 12.Diagnosis
Clinical Presentation: Abdominal mass, urinary tract infections, and hydronephrosis 2.
Imaging: Ultrasound, CT urography, and MRI are crucial for visualizing dilated ureters and assessing the extent of hydroureteronephrosis 2.
Urodynamic Studies: Useful in evaluating functional obstruction 3.
Grading: Typically assessed based on degree of dilation and impact on renal function, though specific grading systems are not detailed in provided abstracts 12.Management
Surgical Interventions:
- Extravesical Techniques: Leech-Gregor Uretroneocystostomy for primary megaureter 1.
- Intravesical Plication and Reimplantation: Effective for grossly dilated ureters, particularly in pediatric cases, with low morbidity and high success rates 3.
Adjunctive Treatments: Not specifically detailed in provided abstracts.Special Populations
Pediatrics: Megaureters frequently require surgical intervention due to developmental anomalies and significant morbidity 23.
Comorbidities: Specific management adjustments for comorbidities like aganglionosis are noted in individual cases but not generalized 1.Key Recommendations
Surgical Correction for Symptomatic Megaureter: Early surgical intervention, such as extravesical or intravesical techniques, is recommended for symptomatic megaureter to prevent renal damage 13 (Evidence: Strong).
Imaging for Diagnosis: Utilize advanced imaging modalities like CT urography and MRI for accurate diagnosis and assessment of hydroureteronephrosis 2 (Evidence: Moderate).
Plication and Reimplantation in Children: Intravesical plication and reimplantation offers a viable surgical option with favorable outcomes in pediatric patients with megaureters 3 (Evidence: Moderate).References
1 Abid SS, Aslam M, Khan S, Feroz I, Rais A. Complicated megaureter with aganglionosis in an adult lady. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2010. link
2 Rastogi R. Giant megaureters presenting as a multicystic abdominal mass. Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2008. link
3 Ozen HA, Tekgül S, Erkan I, Bakkaloğlu M. Intravesical ureteric plication and reimplantation for megaureters in children. British journal of urology 1993. link