Classification of Primary Non-refluxing Megaureter Depending on Disease Progress / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We report on the standards for determining the obstructive type and the non-obstructive type of primary non-refluxing megaureter, and we also report on the diagnostic and therapeutic approach for such patients. MATERIALS AND METHODS: We evaluated 28 children diagnosed with primary non-refluxing megaureter from Jan 2000 to Feb 2003. We assessed the changes in hydronephrosis and dilated ureteral diameter at 2 and 6 months after surgery (the surgery group) and on the diagnosed 'wait and see' group. RESULTS: Out of 28 children, 14 children underwent ureteroneocystostomy. The mean diameter of the dilated ureter was decreased significantly from 20.3mm at initial presentation to 9.3mm and 3.4mm at 2 and 6 months, respectively, after surgery in the surgery group (p=0.0063, 0.0027), and from 21.1mm to 6.7mm and 4.8mm at 2 and 6 months, respectively, after diagnosis in the 'wait and see' group (p=0.0247, 0.0154). The mean grade of hydronephrosis was decreased significantly from 3.6 to 2.7 and 2.13, respectively, in the surgery group (p=0.0044, 0.0003), and from 2.35 to 1.53 and 1.12, respectively, in the 'wait and see' group (p=0.0026, 0.0006). However, the difference in the percentage of decrease in the mean ureteral diameter and the grade of hydronephrosis compared to the values at the initial presentation was not significant between the two groups (p=0.4168, 0.8999). When diuretic renography (DRG) was done in the surgery group, only 15 ureters (20%) showed an obstructive pattern with T1/2 above 20 minutes. CONCLUSIONS: The discrimination of obstruction and non-obstruction is the most important factor for the prognosis and treatment plan of primary non-refluxing megaureter. It is possible to correctly evaluate this condition by comparison of the change in the pattern of disease through continuous, periodic evaluation and follow-up. Surgical treatment such as ureteroneocystostomy must be considered when breakthrough urinary tract infection (UTI), aggravation of hydronephrosis or marked decrease of renal function is present during conservative treatment or observation.