Question

Treatment options of obstructive megaureter.

Hint:

Obstructive megaureter may require surgical intervention such as ureteral reimplantation or pyeloplasty to relieve the obstruction and preserve kidney function.

Answer 1

The treatment of obstructive megaureter depends on the severity of the condition, the age of the patient, and the specific cause of the obstruction. Treatment aims to relieve the obstruction, prevent further damage to the kidney, and preserve renal function.
Step 1: Conservative Management:
1. Observation: In some mild cases, especially in children, the condition may be monitored with regular imaging and clinical follow-up. This is often done in cases of partial obstruction where the kidney function is not significantly compromised.
2. Antibiotic Prophylaxis: If recurrent urinary tract infections are a concern, antibiotic prophylaxis may be prescribed to prevent infections.
Step 2: Surgical Treatment:
1. Ureteral Reimplantation: In cases where the obstruction is at the ureterovesical junction (UVJ), the surgeon may perform a ureteral reimplantation, where the ureter is surgically reattached to the bladder to relieve the obstruction and ensure normal urine flow.
2. Pyeloplasty: If there is an obstruction higher up in the ureter or in the renal pelvis, a pyeloplasty may be performed to remove the obstructed section and restore normal drainage.
3. Endoscopic Treatment: In some cases, endoscopic procedures such as balloon dilation or stenting may be used to alleviate the obstruction without open surgery.
Step 3: Postoperative Care and Monitoring:
- After surgery, patients are monitored for complications such as infection, leakage, or recurrence of the obstruction. Follow-up imaging, including ultrasound or CT scans, is used to assess kidney function and ensure that the obstruction is resolved.
- Long-term management may include regular renal function tests and blood pressure monitoring to ensure there is no ongoing kidney damage.