Congenital Megaureter

Lee, Sang Ju; Yoon, Jong Byung

Abstract

Megaureter is a short descriptive term applied aptly to the ureter or ureters that are out of proportion to the rest of the urinary tract. Unfort unately, the term megaureter has been applied more loosely to a variety of congenitally and massively dilated ureters to the extent that it has become nonspecific in meaning. In this report a classification was proposed according to Belman's classification, such as primary, obstructive and refluxing megaureter. Five cases of megaureter were presented with literature. Case 1: A 35-year-old man was admitted because of bilateral flank dull pain and palpable mass. IVP, cystoscopy, RGP and cystography revealed primary megaureter (Rt) and UPJ stricture (Lt). Anderson-Hynes pyeloplasty (Lt) performed, but conservative management has been applied for primary megaureter( Rt). Case 2: A 7-year-old girl was admitted because of persistent pyuria. IVP showed primary megaureter (Lt), possibly. Thus, Politano-Leadbetter ureteroneocystostomy without ureteral tailoring or nephrostomy performed uneventually. Patient's urinalysis noted no pyuria post-operatively. Case 3: A 33-year-old housewife was admitted because of Lt flank dull pain and pyuria. IVP, cystoscopy, RGP and cystography revealed primary megaureter (Lt). Thus, Politano-Leadbetter ureteroneocystostomy without ureteral tailoring or nephrostomy applied uneventually postoperative result was good. Histologic examination of the removed distal ureter showed submucosal infilteration of chronic inflammatory cells, mural fibrosis and relatively normal muscular layer. Case 4: 1 and 1/3-year-old child was admitted because of severe pyuria. IVP and cystography revealed bilateral refluxing megaureter. After Foley catheterization and antimicrobial therapy had applied for about 6 months. Politano-Leadbetter ureteroneocystomy without ureteral tailoring or nephrostomy performed uneventually. Post operative urinalysis and IVP (1 year later) revealed normal finding. Histologic examination of the removed distal ureter showed sub-mucosal infilteration of chronic irflammatory cells, mural fibrosis and hypertrophy of circular muscle fiber with weakened longitudinal muscle fiber. Case 5: A 42-year-old housewife, who had received Lt nephrectomy for unknown etiology, was admitted because of Lt lower abdominal discomfortness and pyuria. IVP, cystoscopy RGP and cystography revealed refluxing megaureter (Rt). Thus Politano-Leadbetter ureteroneocystostomy with nephrostomy performed. Postoperative result was grave.