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Clin Case Rep 2022 Apr 8;10(4):e05677. Epub 2022 Apr 8.

Urology Department Theodor Bilharz, Research Institute Cairo Egypt.

A 4-month-old boy presented with left inguinal swelling, and the examination was notable for an inguinal hernia; ultrasonography and CT revealed that the hernia content was hugely dilated ureter of ureteral-inguinal hernia caused by primary obstructed megaureter. Imaging of pediatric inguinal hernia elucidates contents, etiology, and guide for proper surgery. Read More

J Pediatr Urol 2021 08 6;17(4):581-582. Epub 2021 Jul 6.

Department of Pediatric Surgery, University Hospital Vall d´Hebron, Barcelona, Spain; Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain; Universidad autónoma de Barcelona, Hospital Vall d´Hebron, Passeig de la Vall d´Hebrón 119-129, 08035 Barcelona, Spain.

Introduction: In this video we aim to describe step-by-step a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR).

Material And Methods: A transperitoneal approach is used in all cases. The distal ureter is dissected and transected at the level of the stenosis. Read More

Ultrastruct Pathol 2021 May 27;45(3):257-265. Epub 2021 Jul 27.

Department of Urology, Theodor Bilharz Research Institute, Cairo, Egypt.

Congenital primary obstructive megaureter (POM) is an uncommon pediatric anomaly that is due to obstructive distal ureter leading to the loss of peristalsis with consequent ureterohydronephrosis causing loss of kidney function. The objectives are to elucidate the etiology of POM by demonstrating the presence of interstitial cells of Cajal (ICC), telocytes, smooth muscles, and collage in the obstructive and dilated ureteral segments. The study was carried out on 15 surgical specimens of congenital POM in pediatric patients, age range was 4 to 24 months, they were operated upon by excision of the obstructed segment, tailoring the dilated ureter, and anastomosing it to the bladder. Read More

J Endourol Case Rep 2020 29;6(4):358-361. Epub 2020 Dec 29.

Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Primary obstructed megaureter (POM) usually refers to primary dilated ureters in which vesicoureteral reflux and other secondary causes of lower ureteral obstruction have been ruled out. We herein present a case of obstructed megaureter with a dilated saccular lower end representing an ureterocele and concomitant multiple multifaceted stones almost completely filling the dilated tortuous ureter of a normally functioning and excreting kidney. Our index case was a 45-year-old lady with intermittent right flank pain for a year with acute colic since a week. Read More

Urology 2021 03 28;149:216-221. Epub 2020 Oct 28.

Division of Urology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA; Division of Urology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Care, 3400 Civic Center Blvd, 3(rd) Floor West Pavilion, Philadelphia, PA.

Objective: To describe the technical aspects of robot assisted laparoscopic ureteral reimplantation (RALUR) for the management of primary obstructive megaureter (POM) and report initial outcomes, safety, and feasibility of the procedure.

Methods: Using an IRB- approved robotic surgery registry, we performed a retrospective chart review of patients undergoing RALUR for POM between April 2009 and May 2019.

Results: A total of 18 patients underwent RALUR using a modified Lich-Gregoir technique for management of POM and 7 (38. Read More

Urology 2021 03 26;149:211-215. Epub 2020 Oct 26.

Department of Urology, Shamir Medical Center, Zerifin, Israel.

Objective: To compare 2 minimally invasive surgical options for the treatment of obstructed megaureter: robot assisted dismembered extravesical cross-trigonal ureteral reimplantation (RADECUR) and laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation (LDECUR).

Methods: A 2 arm retrospective comparative study, including all pediatric patients who underwent ureteral reimplantation of unilateral obstructed megaureter, either by RADECUR or LDECUR. Patient demographics, perioperative surgical data, complications, and results are described. Read More

J Endourol Case Rep 2019 30;5(3):88-91. Epub 2019 Aug 30.

Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.

Congenital mid-ureteral stricture (CMUS) is a rare diagnosis almost exclusively repaired with ureteroureterostomy in infancy or early childhood. We describe a unique case of a 2-year-old child with both a CMUS and ipsilateral obstructed megaureter, which was addressed in a single operative setting using a robotic Heineke-Mikulicz nondismembered ureteroplasty for the CMUS and a dismembered tapered extravesical ureteral reimplant for the obstructed megaureter. Compared with ureteroureterostomy, a nondismembered ureteroplasty for CMUS minimizes the risk of ureteral vascular compromise and can be particularly beneficial in cases where the affected ureter requires additional reconstruction. Read More

J Laparoendosc Adv Surg Tech A 2020 Mar 26. Epub 2020 Mar 26.

Department of Pediatric Surgery & Urology, University Hospital of Vall d'Hebron, Barcelona, Spain.

Conservative management of primary obstructive megaureter (POM) appears as the best option in patients with adequate ureteral drainage. Nevertheless, surgical intervention is indicated in cases of recurrent urinary tract Infections (UTIs), deterioration of split renal function, and significant obstruction. The gold standard includes: Ureteral reimplantation with or without tapering by open approach. Read More

Front Pediatr 2020 6;8:62. Epub 2020 Mar 6.

Department of Pediatric Surgery, Qilu Hospital, Shandong University, Jinan, China.

To report our initial experience with a modified ureteral orthotopic reimplantation technique under pneumovesicum and compare the outcomes vs. those obtained with the Cohen technique under pneumovesicum for the correction of primary obstructive megaureter (POM) or vesicoureteral reflux(VUR) in pediatric patients. A total of 46 patients (38 POM and 8 VUR; mean age: 16. Read More

J Endourol 2020 03 2;34(3):249-254. Epub 2020 Mar 2.

Departments of Urology and Pediatric Urology, Shaare Zedek Medical Center, Jerusalem, Israel.

To describe our experience with robot-assisted laparoscopic dismembered extravesical cross-trigonal ureteral reimplantation (RADECUR)-a novel minimally invasive surgical technique for treatment of obstructed megaureter. A retrospective review of our prospectively collected data, of all pediatric patients who underwent unilateral RADECUR for the treatment of primary or secondary obstructed megaureter at two medical centers during a 3-year period. Patient demographics, perioperative data, surgical technique, complications, and results are described. Read More

J Comp Pathol 2019 Jul 15;170:101-104. Epub 2019 Jul 15.

Laboratório de Patologia do Departamento de Clínica e Cirurgia Veterinárias. Electronic address:

A rare case of bilateral, primary, obstructive, giant megaureter was found during necropsy examination of an 11-year-old female German shepherd dog. On ultrasound examination and at necropsy examination, both ureters were tortuous and extensively dilated with diameter ranging from 1.86 to 4. Read More

J Pediatr Surg 2020 Mar 5;55(3):564-569. Epub 2019 Jul 5.

Department of Pediatric Surgery, University Hospital Vall d'Hebron, Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035 Barcelona, Spain; Universitat Autónoma de Barcelona, Hospital Vall d'Hebron, Passeig de la Vall d'Hebrón 119-129, 08035, Barcelona, Spain.

Purpose: To describe a simplified surgical technique for the treatment of primary and secondary obstructed megaureters in children by laparoscopic extravesical ureteral reimplantation (LEUR) and evaluate the short-term outcomes.

Methods: Prospective study of children with primary and secondary megaureters treated at our institution between 2016 and 2018 by LEUR. A transperitoneal approach was used in all cases. Read More

Front Pediatr 2019 9;7:127. Epub 2019 Apr 9.

Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.

Hypotonia-Cystinuria syndrome (HCS) is a rare disease, caused by a mutation in two contiguous genes (SLC3A1 and PREPL) localized on chromosome 2p21, and it is characterized by both renal involvement with cystine stones and nervous involvement with hypotonia. We here describe a 2 years old child with HCS associated with other clinical features as congenital anomalies of kidney and urinary tract (primary obstructed megaureter, POM), cryptorchidism and cardiac involvement (patent foramen ovale with atrial septum aneurysm). To the best of our knowledge, cryporchidism and POM have never been reported before in patients with HCS. Read More

J Pediatr Urol 2019 05 23;15(3):256.e1-256.e5. Epub 2019 Jan 23.

University of Nebraska Medical Center/Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA. Electronic address:

Introduction: Some infants with obstructed megaureters or ectopic ureters requiring surgery undergo a cutaneous ureterostomy followed by definitive repair after 12 months of age. Since 2013, a 'mini' extravesical reimplant with or without 'mini' tapering (MER) was performed instead of cutaneous ureterostomy in such infants.

Objective: To describe the technique and outcomes for MER. Read More

Biomed Mater Eng 2018 ;29(6):821-837

School of Industrial and Information Engineering, Polytechnic University of Milan, Milan, Italy.

Two common abnormalities in ureters include primary refluxing megaureter (PRM) and primary obstructed megaureter (POM). The aim of this study was to represent the numerical simulation of the urine flow at the end of the ureter with vesicoureteral reflux (VUR) and POM during peristalsis. Methodologically, the peristalsis in the ureter wall was created using Gaussian distribution. Read More

J Pediatr Urol 2018 12 25;14(6):538.e1-538.e7. Epub 2018 May 25.

Pediatric Urology Unit, 'Bambino Gesù' Children's Hospital, Rome, Italy.

Background: It is extremely important to not only address the short-term success following endoscopic correction of vesicoureteral reflux (VUR) but also the long-term efficacy and safety of the tissue augmenting substance utilized for endoscopic correction.

Objective: This study retrospectively evaluated all cases of ureterovesical junction (UVJ) obstruction following endoscopic treatment of VUR over the last 5 years utilizing two tissue augmenting substances, with special emphasis on the safety of Vantris, and performed clinical and histological review of these patients.

Methods: The study population comprised 2495 patients who underwent endoscopic correction of VUR utilizing Deflux (1790) and Vantris (705). Read More

Indian J Radiol Imaging 2018 Jan-Mar;28(1):45-48

Department of Radiodiagnosis, All India Institute of Radiodiagnosis, New Delhi, India.

In infants and young children with suspicion of genitourinary tract anomalies, ultrasonography (USG) is usually the first imaging modality. Advantages of USG are well described. In the evaluation of complex congenital urogenital anomalies, ultrasound examination needs to be tailored according to the clinical suspicion and to yield maximum information. Read More

J Endourol 2018 06;32(6):482-487

Department of Urology, Naval Medical Center San Diego , San Diego, California.

Background: The gold standard treatment for primary obstructive megaureter (POM) with declining renal function, worsening obstruction, or recurrent infections is ureteral reimplantation with or without tapering. In infants, open surgery can be technically demanding and associated with significant morbidity. We conducted a systematic review of the literature with special interest in endoscopic management of POM and its outcomes. Read More

Anat Sci Int 2018 Jun 8;93(3):394-399. Epub 2017 Dec 8.

Department of Anatomy, Dokkyo Medical University, Mibu, Tochigi, 321-0293, Japan.

A unilateral megaureter was found in an elderly female cadaver during routine dissection. The left proximal ureter, which was thick and convolute, descended and entered into the pelvic cavity, where the distal ureter was attached to the posterior pelvic wall at the inlet level. Removal of connective tissue surrounding the attached region revealed ureteric entrapment in the sacroiliac joint. Read More

J Urol 2017 11 22;198(5):995-996. Epub 2017 Sep 22.

Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana.

J Med Case Rep 2017 Jul 1;11(1):177. Epub 2017 Jul 1.

Department of urology, Hassan II University Hospital, Fez, Morocco.

Background: Primary obstructive megaureter is relatively uncommon in adults. This condition usually regresses spontaneously or is treated during infancy. It can remain asymptomatic for decades until adulthood when symptoms may manifest in the event of complications or during a routine radiologic imaging. Read More

J Laparoendosc Adv Surg Tech A 2017 Aug 8;27(8):851-857. Epub 2017 Jun 8.

Department of Pediatric Surgery and Urology, University Hospital of Vall d'Hebron , Barcelona, Spain .

Background: Open surgery is a preferred treatment for primary obstructive megaureter (POM) in cases where the conservative treatment fails, with reported success rates of 90%-96%.

Objective: To describe our initial experience in the treatment of POM by laparoscopic-assisted extracorporeal ureteral tapering repair (EUTR) and laparoscopic ureteral extravesical reimplantation (LUER) by following Lich Gregoir technique as an alternative to open surgery.

Design, Setting, And Participants: A total of 7 patients with POM underwent laparoscopic-assisted extracorporeal ureteral tapering repair and ureteral extravesical reimplantation by following Lich Gregoir technique between 2011 and 2014. Read More

J Urol 2017 11 29;198(5):1159-1167. Epub 2017 May 29.

Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Purpose: A nonrefluxing megaureter is a relatively common cause of antenatal hydronephrosis. Although nonoperative management is favored, surgical intervention is sometimes warranted. However, there is controversy regarding the best approach, particularly in young children. Read More

Urol Ann 2017 Apr-Jun;9(2):150-152

Department of Urology, Yenepoya Medical College, Mangalore, Karnataka, India.

Objective: This study aims to demonstrate a novel laparoscopic technique of tapering megaureter without disrupting the blood supply and disconnecting the ureter.

Materials And Methods: Eight cases of primary obstructive megaureter in the age group of 14-22 years underwent laparoscopic extravesical ureteric reimplantation between August 2011 and July 2015 using our novel technique. Five patients had obstruction on left side and three on right side. Read More

BMJ Case Rep 2016 Dec 15;2016. Epub 2016 Dec 15.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

A 1-year-old male infant presented with fever and abdominal lump for 3 months with increased leucocyte count (15 300/mm) and serum creatinine (0.83 mg%). Abdominal ultrasound and renal scan demonstrated solitary left kidney with dilated tortuous left ureter. Read More

J Pediatr Urol 2017 Feb 24;13(1):47.e1-47.e7. Epub 2016 Oct 24.

Department of Paediatric Surgery and Urology, Princess Margaret Hospital for Children, Perth, Australia; School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia.

Purpose: This study aimed to assess the outcome of intravesical ureteric reimplantation for primary obstructed megaureter (POM) performed in infants under 1 year of age.

Materials And Methods: A retrospective cohort study was carried out of all infants undergoing intravesical ureteric reimplantation surgery for POM at two pediatric centers in the 12 years between 2003 and 2014. Outcomes were compared with those of children aged over 1 year undergoing intravesical reimplantation for POM during this period. Read More

Int Urol Nephrol 2016 Dec 2;48(12):1937-1941. Epub 2016 Sep 2.

Department of Pediatric Surgery, Provincial Hospital Affiliated To Shandong University, Jinan, 250021, China.

Purpose: To describe a modified ureteral orthotopic reimplantation method in infant with primary obstructive megaureter (POM) and report our initial experience.

Methods: Thirteen children with POM (range 1-7 months) underwent modified transvesical ureteral implantation surgery. Treatment consists of transecting the ureter proximal to the obstruction and performing orthotopic reimplantation in end freely fashion with distal ureter protruding into the bladder, providing dilated ureteral diameter: ureteral exposure length in bladder ratio of 1:1. Read More

Arab J Urol 2016 Jun 20;14(2):171-7. Epub 2016 May 20.

Department of Urology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.

Objectives: To present a novel ureteric re-implantation technique for primary obstructed megaureter (POM) that ensures success in the short- and long-term, as conventional techniques are not ideal for megaureters especially in children, with ureteric stenosis and reflux being common complications after re-implantation.

Patients And Methods: Between 2009 and 2012, 22 paediatric patients with POM were enrolled. We performed a new technique for re-implantation of these ureters to ensure minimal incidence of ureteric strictures and easy subsequent endoscopic access. Read More

J Pediatr Urol 2016 Apr 8;12(2):103.e1-4. Epub 2015 Oct 8.

Department of Pediatric Urology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai 600116, India. Electronic address:

Introduction: The management of primary obstructed megaureter (POM) ranges from temporary double-J stenting to conventional ureteric reimplantation with tapering. Of late, several authors have favored refluxing reimplantation. In the present study the outcomes of 'mini reimplantation', where no tapering or advancement of the ureter was performed, have been analyzed. Read More

J Pediatr Urol 2015 Jun;11(3):110-2

Department of Urology, Lurie Children's Hospital, Northwestern University, USA. Electronic address: