Non-refluxing megaureter

Abstract

The primary goal in diagnosing and treating non-refluxing megaureters is to prevent ipsilateral renal function loss. Secondary goals are to minimize associated comorbidities, including febrile UTI (fUTI) and pain. A summary of evidence for these aims is presented: Loss of ipsilateral renal function during observation was reported in ≤10 % of megaureters. Recurrent obstruction occurs in <10 % after surgical repair. Reported UTIs were generally not characterized as febrile versus nonfebrile: Although most patients were males, no study reported circumcision status. All reviews of observation patients reported antibiotic prophylaxis in most or all patients during the first year of life. UTI incidence during observation varied from 6 to 71 %. No study randomized patients to prophylaxis or no treatment; no study related UTI occurrence to circumcision status, initial presentation with UTI or not, extent of hydronephrosis (HN), or renography drainage patterns. The review reporting the highest occurrence of UTI during observation, with 57 % of patients initially diagnosed following UTI, reported that prophylaxis reduced infections. Surgical series did not systematically report UTI occurrence postoperatively. One review found abdominal and/or flank pain as the presenting complaint in 16 % of diagnosed megaureters in children at a mean age of 6 years. Pain did not recur after surgery, or in those selected for observation.