Megaureter
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INTRODUCTION: Low initial differential renal function (DRF) in patients with primary non-refluxing megaureter (PNRM) is considered an indication for surgery as are an increase of dilatation and symptoms. OBJECTIVE: We hypothesized that low DRF is not necessarily a result of obstruction, but may be due to impaired development of the upper urinary tract. Thus, in the absence of symptoms, there is a low risk for further loss of renal function. This study aimed to assess whether initially low DRF is a reliable indicator of obstruction. STUDY DESIGN: We reviewed data from four university centers between 1995 and 2010. Patients under 12 months of age with unilateral primary non-refluxing megaureter (PNMR) and a DRF between 10% and 40%, and followed minimally 24 months, were included. Patients were placed in two groups based on management: group A, surgical; group B, conservative. The dynamics of DRF in relation to age and type of treatment was studied. In each patient we recorded the earliest (initial) DRF, the last known (final) DRF, the age when MAG-3 scans were performed and the type of treatment. RESULTS: From 25 patients, 16 were treated surgically (group A) and 9 followed conservatively (group B). The initial mean DRF in group A was 33.1% and in group B 34.5%, at a mean age 3.0 and 3.6 months, respectively. The final mean DRF in group A was 40.1% and in group B 43%, at a mean age 59.9 and 46.3 months, respectively. Using two-way repeated ANOVA (age [initial DRF, final DRF] vs. group [group A, group B]), we found non-significant difference between the groups in the DRF, F (1, 21) = 0.96, p = 0.338, while we observed statistically significant and similar increase from the initial to final DRF in both groups, F (1, 21) = 16.66, p = 0.001 (Figure). DISCUSSION: This is the first study focusing on the evolution of renal function in patients with PNRM and low initial DRF. Results suggest that the diagnosis of obstruction is inaccurate in most infants with unilateral PNRM if it is based on low initial DRF only. Renal deterioration rarely occurs in asymptomatic patients, and even profoundly impaired kidneys have potential for improvement. Limitations of our study include retrospective design and lack of standardization of treatment among the four centers. CONCLUSION: Low DRF in asymptomatic and anatomically stable patients with PNMR should not be considered an indication for early surgery. These findings challenge current practice and should be confirmed by a prospective study.
- Klíčová slova
- Conservative treatment, Low differential renal function, Primary non-refluxing megaureter,
- MeSH
- časové faktory MeSH
- dilatace patologická MeSH
- kojenec MeSH
- ledviny patofyziologie MeSH
- lidé MeSH
- nemoci močovodu patofyziologie chirurgie MeSH
- retrospektivní studie MeSH
- urologické chirurgické výkony MeSH
- vyšetření funkce ledvin MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
The ureter is a derivate of the Wolffian mesonephric duct and undergoes complex changes during development. The most common developmental anomaly is complete duplication of the ureter. Duplication of the ureter may be complete or incomplete. Incomplete duplication of ureter is well known as bifid ureter. Presence of various anomalies of the ureter is associated with increased risk of urinary tract infections and many other clinical complications.
- Klíčová slova
- Anatomical dissection, Cadavers, Congenital malformations, Duplication of ureter, Megaureter,
- MeSH
- disekce metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- močové ústrojí anatomie a histologie patologie MeSH
- mrtvola MeSH
- senioři MeSH
- ureter abnormality patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The aim of study is to evaluate the results of endoscopic treatment of vesicoureteric reflux (VUR) comparing with conservative mode. METHODS AND RESULTS: In the years 2003-2006 there were forty for children in prospective randomised study enrolled and divided into two groups. Twenty two children 1-40 months old (22.9 months) were operated. Dx/Ha (Deflux) was instilled for VUR grade 3-5. The results of treatment were compared with outcome of twenty two conservatively treated randomly assigned children aged 1-32 months (mean age 13.5 months) Postoperative videourodynamic study was used to evaluate for the presence of VUR and function of the bladder and ultrasound investigation was performed too (exclusion of obstructive megaureter in operated group). There were 22 children controled after instillation. The children were followed 11-24 months. VUR was cured in 12 cases (54.5%) and improved (grade 1-2) in 5 children (66.7%). All children absolved treatment without any complications, excluding one case with obstructive megaureter after pyelonephritis diagnosed. There were 22 children evaluated in conservative group. Five children were cured (22.7%) and VUR was improved (grade 1-2) in four (18.2%) CONCLUSIONS: Endoscopic miniinvasive instillation of dextranomer is safe and effective treatment of VUR in all age groups with good therapeutical outcome and minimum of adverse effects.
- MeSH
- behaviorální terapie MeSH
- elektrická stimulace MeSH
- lidé MeSH
- vezikoureterální reflux farmakoterapie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
A male with a severe form of congenital nephrogenic diabetes insipidus (diuresis 10 l per day) had megaureters, megavesica, large residuum and a history of three traumatic ruptures of the megavesica and a recurrent urinary tract infection (RUTI). Hemodialysis was introduced at 41 years of age. At age of 42, he underwent a bilateral retroperitoneoscopic nephrectomy to prevent further RUTI and 8 months later transplantation of a cadaver kidney. Intermittent catheterization is necessary due to residual urine in the urinary bladder.
AIMS: To compare the quality of MR of urography with intravenous urography, sonography and scintigraphy of urinary tract, presentation of MR urography as a possible substitution of so far used examinations in preoperation diagnostics of anomalies in upper urinary tract. METHODS: Static MR urography was used to examine 51 patients at the age of one month to 18 years with dilation of upper urinary tract detected by sonography. In 12 of them a dynamic MR study of the kidneys was also performed. Magnetic urography was compared with elimination urography, sonography and dynamic kidney scintigraphy. The detection rate was evaluated within the framework of the complex preoperation examinations for different stages of urinary tract in patients up to 2, 6, 12 and 18 years, respectively. RESULTS: In the total number of 36 kidneys, modified by hydronephrosis, magnetic urography was evaluated as more precise in 18 cases, elimination urography in eight and both examinations were considered equal in 10 cases. The imaging of megaureters by MR urography was more precise in 7 cases, elimination urography was at the same level six times and less precise in eight patients. The results differed in individual age categories. Sonography imaging of the kidney was good as well as for the lower portion of ureter but insufficient for the middle portion. The same course of excretion curves in dynamic excretion urography and dynamic scintigraphy of the kidney was reached in 6 patients. CONCLUSION: MR urography is capable to provide information on anatomy and function of the whole urinary tract in a single examination, being different from excretion urography by its ability of imaging and evaluating the hypofunctional part of the kidney. It represents a possibility to significantly reduce present examination which exerts a load upon the patient.
- MeSH
- dilatace patologická diagnóza chirurgie MeSH
- dítě MeSH
- hydronefróza diagnóza chirurgie MeSH
- kojenec MeSH
- ledviny patologie chirurgie MeSH
- lidé MeSH
- magnetická rezonanční tomografie * MeSH
- mladiství MeSH
- obstrukce močovodu diagnóza chirurgie MeSH
- předškolní dítě MeSH
- ureter patologie chirurgie MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- práce podpořená grantem MeSH
The actually used examination algorithm of imaging methods was checked in 35 neonates examined in the course of two years (1991 and 1992) on account of suspected diseases of the urinary pathways. It involved sonographic examination of 28 children, voiding cystourethrography (34x) and intravenous urography (18x). Ascendent pyelography and irrigography were performed three times, one neonate was examined by computed tomography. The procedure used as a basic sonographic prenatal screening in 11 children, in 20 clinical suspicion of disease of the urinary pathways, and four neonates were examined on account of an anorectal malformation or abnormality of the external genitalis. The most frequent finding--in 18 children--was hydronephrosis. It was associated with signs of subrenal obstruction (8x), with ren duplex (5x) and with a megaureter (6x). The association of the sonographic finding of dilatation of the intrarenal urinary pathways with absent contrast filling during excretory urography was observed in a child with hydronephrosis and subrenal obstruction and in four children with a multicystic dysplastic kidney. In individual cases the authors detected a valve of the posterior urethra, a sigmoid-vesical fistula, agenesis of the penis and stenosis of the urethra. Eleven neonates had a normal findings of the urinary tract.
- MeSH
- hydronefróza vrozené diagnóza MeSH
- lidé MeSH
- močové ústrojí abnormality diagnostické zobrazování MeSH
- novorozenec MeSH
- ultrasonografie MeSH
- urografie MeSH
- urologické nemoci vrozené diagnóza MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dilatace patologická vrozené epidemiologie terapie MeSH
- dítě MeSH
- kohortové studie MeSH
- kojenec MeSH
- lidé MeSH
- nemoci močovodu * vrozené epidemiologie terapie MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ureter abnormality MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Treatment results of 74 secondary megaureters in 48 children (25 males and 23 females with one segmental and 73 total megaureters) are presented. The left side prevailed over the right one (ratio 1.4:1.0); the lesion was bilateral in 54%. Forty-two children (88%) were treated surgically. Eleven megaureters (15%) were modelled. and 2 megaureters had to be reoperated. The follow-up period ranged between 7 months and 9.5 years. Urinary infection was reduced from 80 to 54%, chronical renal failure was reduced from 65 to 54%, and the occurrence of arterial hypertension remained unchanged. Excellent results were achieved in 27%, they were satisfactory in 60% and poor in 13% of the megaureters.
- MeSH
- dilatace patologická komplikace chirurgie terapie MeSH
- dítě MeSH
- infekce močového ústrojí etiologie prevence a kontrola MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- následné studie MeSH
- nemoci močovodu komplikace chirurgie terapie MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- retrospektivní studie MeSH
- věkové faktory MeSH
- Check Tag
- dítě MeSH
- kojenec MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- dilatace patologická chirurgie MeSH
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- ureter abnormality chirurgie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- dilatace patologická klasifikace etiologie MeSH
- lidé MeSH
- nemoci močovodu * klasifikace etiologie MeSH
- terminologie jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
