SOVREMENNAYA PEDIATRIYA.2016.2(74):147-150; doi 10.15574/SP.2016.74.147 

Diagnosis and treatment of obstructive megaureter in young children 

Kokorin A. D.

Zaporozhye State Medical University, Ukraine 

Congenital megaureter is one of the most severe urological diseases of childhood. The frequency of this disease in recent years has a tendency to decrease. 

Objective: To evaluate the effectiveness of early diagnosis and treatment megaureter young children. 

Materials and Methods: The study of materials examination and surgical treatment of 34 children with obstructive megaureter. The children were divided into two comparable age and sex groups: primary (n=16) and control (n=18). In the main group of staged diagnosis is confirmed by the results of prenatal ultrasound and fetal MRI. Children in the control group was established at the time of defect treatment in the clinic with symptoms of pyelonephritis. During treatment groups compared the dynamics of the US of kidneys and bladder, the results of preoperative voiding cystography, excretory urography, and Doppler sonography.

Results and discussion for the correction of the defect in the main group, 50% of children used the methods of intravesical endoscopic correction of the defect using a technique stenting, which was effective in 75% of cases. In 31.3% of cases in children with moderate defect used conservative therapy. The open method of defect correction used only in 18.7% of cases. In the control group the use of endoscopic correction of the defect was effective only in 16.1% of patients. In other cases, we use multi-stage «open» technique. The choice of the defect correction affected the long-term results of surgical treatment. In children with primary use of endoscopic correction of the defect number of pyelonephritis was observed in 18% of patients. In the control group, with primary use of open methods of operating pyelonephritis were observed in 77.7% of cases (p <0,05).

Conclusion: Early diagnosis megaureter using staged ultrasound and MR imaging allows you to expand the indications for the use of endoscopic correction of the defect, effectively use methods of conservative therapy and reliably predict long-term outcomes.

Key words: megaureter, diagnosis, treatment, children.

REFERENCES

1. Adamenko OB, Halepa ZA, Kotova LY. 2006. Prenatal ultrasound diagnosis of congenital anomalies of the urinary system. Pediatric Surgery. 1: 13-16.

2. Ainakulov AD, Mailybaev BM. 2014. A differentiated approach to the treatment of primary obstructive megaureter children. Pediatric Surgery. 5: 16-18.

3. Dovlatyan AA. 2005. Surgical treatment of neuromuscular dysplasia of the ureter. Urologiya. 3: 38-43.

4. Pugachev AG, Kudryavtsev YV, Voronovitsky VD. 2003. Long-term results of surgical treatment of neuromuscular dysplasia of the ureter in children. Urology. 6: 58-60.

5. Khvorostov IN, Zorkin SN, Smirnov IE. 2005. Obstructive uropathy. Urology. 4: 73-76.

6. Doletsky SJ, Shanidze VV, Rhine UA, Krasilnikov VA. 1980. Surgical tactics in megaureter only kidney in children. Questions of Experimental and Clinical Urology. 3: 26-29.

7. Sheu JC, Chang PY, Wang NL et al. 1998. Is surgery necessary for primary nonrefluxing megaureter? Pediatric Surgery International. 13; 7: 501—503.

8. Ottolenghi A, Campagnola S, Sulpasso M. 1988. Should primary megaureter be treated d'emblee in the neonate? Zeitschrift fur Kinderchirurgie. 43; 3: 154—155.

9. Shukla AR, Cooper J, Patel RP et al. 2005. Prenatally detected primary megaureter a role for extended follow up. J Urol. 173(4): 1353—1356.

10. Angerri O, Caffaratti J, Garat JM, Villavicencio H. 2007. Primary obstructive megaureter: initial experience with endoscopic dilatation. J Enourol. 21(9): 999—1004. http://dx.doi.org/10.1089/end.2006.0122; PMid:17941775