Ogunfusika Oluseyi H, Adewoye Ayodeji O
Urology, Kettering General Hospital NHS Foundation Trust, Kettering, GBR.
Accident and Emergency, Kettering General Hospital NHS Foundation Trust, Kettering, GBR.
Cureus. 2025 Oct 5;17(10):e93895. doi: 10.7759/cureus.93895. eCollection 2025 Oct.
Megaureter, characterised by a dilated ureter without evidence of obstruction at the vesicoureteral junction, is a condition primarily associated with paediatric populations. It is often diagnosed early in life due to urinary tract infections, hydronephrosis, or other urinary symptoms. In contrast, megaureters in adults are rarely encountered, particularly in asymptomatic individuals. This discrepancy in age-related presentation raises important questions regarding the natural history, detection, and clinical relevance of the condition in older patients. This paper presents a rare case of an incidentally discovered, asymptomatic megaureter in an 80-year-old adult female who underwent abdominal imaging for new, declining renal function. Radiologic evaluation revealed bilateral markedly dilated ureters, right more than the left. The patient reported no history of urinary tract infections, flank pain, haematuria, or voiding difficulties. A comprehensive workup ruled out secondary causes, such as obstructive uropathy, neurogenic bladder, or ureteral stricture, supporting a diagnosis of megaureter. In paediatric practice, primary megaureters are well-documented. Many are identified via prenatal ultrasound or early postnatal imaging and may require surgical intervention depending on the degree of dilation and associated complications. Conversely, the literature on adult megaureters, especially asymptomatic cases, is extremely limited, with only a handful of case reports and small series available. The condition may remain clinically silent for decades, only to be discovered incidentally during imaging for unrelated conditions, as in our case. While intervention is often unnecessary in asymptomatic individuals with preserved renal function, proper identification is important to guide follow-up, prevent potential complications and distinguish benign congenital anomalies from acquired pathologies such as malignancy or obstructive uropathy. Surgical interventions, such as reimplantation of the ureter and endoscopic balloon dilatation, are reserved for some cases.
巨输尿管的特征是输尿管扩张，在膀胱输尿管连接处无梗阻迹象，这是一种主要与儿科人群相关的病症。由于尿路感染、肾积水或其他泌尿系统症状，该病常在生命早期被诊断出来。相比之下，成人巨输尿管很少见，尤其是在无症状个体中。这种与年龄相关的表现差异引发了关于老年患者该病症的自然病程、检测及临床相关性的重要问题。本文介绍了一例罕见病例，一名80岁成年女性因新出现的肾功能下降接受腹部影像学检查时偶然发现无症状性巨输尿管。放射学评估显示双侧输尿管明显扩张，右侧比左侧更严重。患者无尿路感染、胁腹疼痛、血尿或排尿困难史。全面检查排除了继发性病因，如梗阻性尿路病、神经源性膀胱或输尿管狭窄，支持巨输尿管的诊断。在儿科实践中，原发性巨输尿管有充分记录。许多是通过产前超声或出生后早期影像学检查发现的，可能需要根据扩张程度及相关并发症进行手术干预。相反，关于成人巨输尿管的文献，尤其是无症状病例，极其有限，仅有少数病例报告和小系列研究。该病可能在临床上隐匿数十年，仅在因无关病症进行影像学检查时偶然被发现，就像我们的病例一样。虽然对于肾功能保留的无症状个体通常无需干预，但正确识别对于指导随访、预防潜在并发症以及区分良性先天性异常与获得性病变（如恶性肿瘤或梗阻性尿路病）很重要。手术干预，如输尿管再植和内镜球囊扩张，仅适用于某些病例。
