Ureteral meatotomy as an option in the management of primary obstructive megaureter in neonates and infants.

Arch Esp Urol 2017 Apr;70(3):349-356

Director de la Escuela Internacional de Urología Pediátrica y fetal del ILMO Colegio de Médicos de Málaga. España.

Differentiating between the cases of megaureter that require surgery and the ones in whom treatment can be delayed is challenging. A large number of surgical techniques for the treatment of POM been proposed aiming mainly to reduce renal damage by relieving the affected ureter. Resection of the affected ureteral segment followed by vesicoureteral reimplantation either with or without reduction ureteroplasty is the classic treatment, however posing a high rate of complications when performed in patients aged less than one year. Endoscopic techniques have also been described to avoid external diversion. Recently, refluxing ureteral reimplantation has been proposed as a temporary treatment for patients with POM.

Objective: To describe the ureteral meatotomy technique as an alternative to the refluxing ureteral reimplantation for POM in patients aged less than one year.

Method: Retrospective study of patients with POM undergoing ureteral meatotomy, aiming to temporarily relieve the ureter. The procedure consists of a 1.5 cm-long cut made with scissors on the upper edge of the ureteral ostium at the 12 o'clock position, until the dilated portion of the ureter was found and abundant urine drainage was observed. The edges of the incision were sutured, joining together the ureteral mucosa and the bladder mucosa.

Result: From 2011 to 2015, three patients with POM underwent ureteral meatotomy, with four renal units treated altogether. None of the patients presented complications and, as a sign of obstruction relief, all showed reduced dilatation at the ultrasound. No patient had complications.

Conclusions: Ureteral meatotomy is a safe and effective technique in the initial treatment of POM in patients aged less than one year.

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April 2017
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