Le mégauretère primitif de type obstructif : stratégies thérapeutiques à propos de 30 cas

Abstract

Objectives: To present the natural history of primary obstructed megaureters, and to reassess the therapeutic approach towards patients based on both the natural history and the etiologies of the disease. Subjects and methods: We conducted a retrospective review of 30 children between newborn and 15 years of age who were followed and treated for primary obstructed megaureters between January 1996 and February 2008 in the department of urology at the Point G hospital. They were divided into 2 groups based on etiology: group A included 16 children with an antenatal etiology and group B included 14 children with a post-natal etiology. The patients were evaluated by ultrasound of the urinary system, voiding cystourethrography, scintigraphy, and magnetic resonance imaging. Results: Of the 30 children included in the study 25 were males. The mean age in group A was 32 weeks and 3 days of gestation, and 4 years in Group B. The megaureter was located on the left side in 48% of cases, on the right side in 30%, and was bilateral in 22%. The megaureter was obstructed and nonrefluxing in 87% of cases, obstructed and refluxing in 13%. The follow-up period was 4.2 ± 1.4 years in group A and 3.6 ± 1.2 years in group B. Half of the patients had a spontaneous regression of their retrovesical ureteral dilation within the first 2 years of life. A surgical procedure was required for 63% of the patients. Conclusion: This study showed the importance of early diagnosis, and clinical and radiologic surveillance as a first step in the care of megaureters. A conservative approach can result in the spontaneous resolution of the megaureter.

Keywords: Megaureter; Surveillance; Surgery

African Journal of Urology (2013) 19, 107–112