Primary non-refluxing megaureter: need for conservative treatment.

PURPOSE

In the last two decades, many reports have confirmed the efficacy and safety of the conservative treatment of non-refluxing megaureter in asymptomatic patients and many cases of ureteral dilatation tend to resolve spontaneously. We report our experience on 108 patients with primary non-refluxing megaureter detected prenatally or diagnosed after birth and we discuss our results with long-term non surgical treatment.

MATERIAL AND METHODS

All patients were evaluated by ultrasound (US), voiding cystourethrogram (VCUG) and MAG3 renography. Observation period ranged from 6-72 months (mean 29.1).

RESULTS

Surgery was performed in 12 patients (11.1%) with severe hydroureteronephrosis. Complete resolution or significant improvement was noted in 80 cases (74%) and persisted in 16 cases (14.8%). In the group with spontaneous resolution the ureteral diameter was less than in patients without resolution. Megaureters grade 1 to 3 tended to resolve between 12 and 36 months of observation.

CONCLUSION

Conservative management is the treatment of choice in primary non refluxing megaureter. The grade of hydroureteronephrosis is an important predictor factor and infants should be followed periodically with renal ultrasound and diuretic renography.