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'Obstructed Megaureter' (83)


Dec
2017

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.

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Jul
2017

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.

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Aug
2017

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%.
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.
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.

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Nov
2017

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.

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Nov
2017

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

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Dec
2016

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.

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Feb
2017

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

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Dec
2016

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

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Jun
2016

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.
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.

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Apr
2016

'Mini reimplantation' for the management of primary obstructed megaureter.

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

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Aug
2014

This paper focuses on a novel modified technique about the treatment of adult obstructed megaureter by the transperitoneal laparoscopic procedure. With the improvement of the laparoscopic surgery, many urological surgeries can be safely and effectually performed by laparoscopic approach. The previously reported laparoscopic methods for treatment of adult obstructed megaureter were complex and time-consuming.

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Dec
1969

The inguinal approach to the distal part of the ureter allows the surgeon to perform various types of procedures and is considered to be one of the minimally invasive techniques in pediatric surgery. We aim to describe our initial experience with the surgery of the distal ureter performed through an inguinal mini-incision.
Between March 2012 and June 2013, 8 patients were treated using a minimally invasive inguinal technique.

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Oct
2014

An obstructed megaureter can be managed using a number of techniques, with the primary goal being to minimize the potential for further injury to the affected kidney. Classically, these obstructed ureters have been treated using cutaneous ureterostomy. However, this technique has certain limitations including the potential for stenosis.

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Jun
2013

A large congenital paraureteric diverticulum has not been reported earlier in combination with bilateral obstructed megaureter. We present one such case in an adolescent male with decreased bladder capacity and renal failure. A single sitting surgical procedure included diverticulocystoplasty with bilateral ureteric reimplantation.

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Dec
1969

The aim of this study was to analyze the results of surgical and conservative treatment of non-refluxing POM. In the period 2000-2009, 45 children (52 ureters) were treated, the average age was 5.8 months (±10.

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Sep
2013

The controversy in management of primary obstructed megaureter necessitates further elucidation of the underlying pathophysiology. We evaluated smooth muscle contractility, and cholinergic, adrenergic and serotonergic activity of rabbit distal ureters after ureterovesical junction (UVJ) obstruction.
Sham (SH) operation, partial obstruction (PO) and complete obstruction (CO) of the right UVJ were performed in rabbits.

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Nov
2013

To describe a novel technique using extracorporeal tailoring and an inverted ureteral nipple to perform laparoscopic transperitoneal ureteral reimplantation for adult obstructed megaureter and our initial experience with 10 patients.
Ten patients (mean age 39.2 years [range, 21-62]) with adult obstructed megaureter underwent transperitoneal laparoscopic ureteral reimplantation by a 3- or 4-port technique.

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Feb
2013

A prospective review of conservative management of primary non-refluxing megaureters (PM) was performed to determine the time taken for resolution (TTR) and complications.
Patient details were obtained from a prospectively maintained database from January 1, 2003, to December 31, 2011. The clinical features of USS and MAG3 findings were analyzed.

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Apr
2012

To present the results of our experience with combined endoureterotomy and endoscopic injection of dextranomer/hyaluronic acid (Deflux) for the treatment of primary obstructive refluxing megaureter (PORM).
Eighteen children (12 female, 6 male; mean age-14 months) with 20 PORM units underwent concomitant endoureterotomy and endoscopic subureteral Deflux injection. All patients underwent endoureterotomy at the 6-o'clock position with insertion of a 3F Double-J ureteral stent into the obstructed segment of ureter and subureteral injection of Deflux at the 5-o'clock and 7-o'clock positions.

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Apr
2012

Although conservative management is indicated in most cases of primary obstructed megaureter (POM), surgery is still indicated when POM is associated with increasing dilation, symptoms, or progressive renal damage. Surgery is associated with a significant rate of complications, however, especially in the case of very large ureter in the first year of life. A valid alternative could be endoscopic high pressure balloon dilation (EHPBD) of the vesicoureteral junction (VUJ).

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Jul
2011

To study the diagnostic and outcome aspects of antenatally diagnosed primary megaureters and analyse the results of the postnatal medicochirurgical management.
The authors report a retrospective analysis of 12 patients been born between 1998 and 2009 with primary megaureter antenatally diagnosed between 20 and 32weeks of gestation. A postnatal radiological assessment comprising urinary tract ultrasound, DTPA or MAG3 renal scintigraphy, retrograde cystography, DMSA renal scintigraphy and intravenous urography was performed.

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Dec
2010

A 20-day-old male neonate presented with fever and hydronephrosis. Evaluation revealed that the patient had a single left kidney and a rare combination of multiple congenital malformations: upper pole segmental multicystic dysplasia, ureteropelvic junction obstruction, and an obstructive and refluxing megaureter (ureterovesical junction obstruction). We performed percutaneous drainage of the infected and obstructed upper collecting system and then used a sequential approach to manage the patient's anomalies.

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Feb
2011

Respiratory distress due to urinary tract obstruction can be a urologic emergency. We describe the diagnostic and surgical management of severe respiratory distress in a neonate due to a crossed ectopic obstructed megaureter in a duplicated pelvic kidney.

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Mar
2011

To discuss the clinical implications of primary obstructed congenital megaureter in the adult and illustrate a minimally-invasive approach for surgical intervention.
We present the case of a 51-year-old man with a longstanding history of symptomatic congenital megaureter, illustrating an approach for robot-assisted tapered ureteral reimplantation. Ureteral dissection, tapering, and nonrefluxing ureteroneocystostomy were all completed using a robot-assisted laparoscopic technique.

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Apr
2011

To analyse the long-term outcome of 16 infants with primary obstructive megaureter managed by (endoscopic or open) stenting over a 10-year period.
A retrospective case-note and imaging review was performed between 1997 and 2007. Data are presented as medians (range) and were compared using the Mann-Whitney test.

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Mar
2010

[Complete ureteral triplication--an anatomic rarity].

Aktuelle Urol 2010 Mar 17;41(2):131-3. Epub 2009 Nov 17.
E Reichenbach-Klinke, M Menninger, S Subotic
Ureteral duplications are a common malformation of the urinary tract. A complete triplication however, is very rare.
We report the case of a 26-year-old female patient admitted because of a septic disorder.

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Jul
2009

Abstract Aim: To evaluate safety and efficacy of 5-mm Hem-o-lok clips in children undergoing retroperitoneoscopic nephrectomy. Material and Methods: Twenty-four retroperitoneoscopic nephrectomies were performed between September 2004 and August 2007. The indications of nephrectomy were ureteropelvic junction obstruction, reflux nephropathy, ectopic ureteral opening with renal dysplasia, and stone disease with pyonephrosis and primary obstructed megaureter with renal dysplasia.

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Apr
2009

We report a case of a 41-year-old man with a solitary functioning left kidney and history of chronic pelvic discomfort associated with lower urinary tract symptoms. Imaging revealed a large cystic structure in the pelvis attached to a dilated tortuous ureter on the right with congenital absence of the right kidney. The patient underwent laparoscopic removal of the pelvic cyst and dilated right ureter.

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Dec
2005

Primary non-refluxing megaureters.

J Pediatr Urol 2005 Dec 5;1(6):409-17. Epub 2005 Jul 5.
E Merlini, P Spina
Megaureters may be primary or secondary, and the dilatation may be due to obstruction or reflux, or both or neither. The cause of primary obstructed megaureter is the aperistaltic and narrowed pre-vesical portion of the ureter. The inner sheath of the terminal ureter generally shows a reduced amount of longitudinal smooth muscle bundles and an increased amount of collagen.

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Jan
2008

Initial management of patients with primary nonrefluxing megaureter (PNRM) associated with impaired renal function or with high risk rate of decreased kidney function can be a dilemma. We present our experience in the use of double -J stent in these patients to evaluate the role as a method to decompressing the system, to prevent function loss or to temporize surgical treatment.
In the period 1996-2006 27 patients were diagnosed of PNRM.

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Jul
2007

To describe a new approach to the treatment of primary obstructive megaureter (POMU) using endoscopic endoureterotomy. The results obtained with this technique are reviewed with long-term follow-up.
A total of 47 children (mean age 3.

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Jul
2007

Recent reports showed an altered density of interstitial cells of Cajal (ICCs) and of peripherin immunoreactive nerve fibres in obstructed uretero-pelvic junction. Our aim was to investigate ICCs immunoexpression and ureteral innervation in primary obstructive megaureter (POM).
8 specimens of POM were obtained during tailoring.

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Jul
2007

We compared myocyte apoptosis index, microvessel density and nerve supply as well as muscular and collagen composition in the obstructed ureteral endings of children with primary obstructive megaureter and normal controls.
Tissue specimens were obtained during ureteral reimplantation in 16 patients with primary obstructive megaureter. For the control group normal ureteral endings were taken at autopsy from 19 age and sex matched children.

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Apr
2006

Primary megaureter presents a spectrum of findings ranging from mild, clinically unimportant, stable ureterectasis to severe, progressive obstructive hydroureteronephrosis. We report a patient with a double uterus and ipsilateral renal dystrophy. A previous imaging study had revealed a double uterus and obstructed left hemivagina, into which a single vaginal ectopic ureter inserted.

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Jul
2005

We present a patient with left-sided obstructed megaureter secondary to neuropathic bladder. He was referred for technetium-99m dimercaptosuccinic acid ((99m)Tc-DMSA) renal cortical scintigraphy to evaluate renal cortical function. Images obtained 4 hr after injection showed significant activity in the dilated left ureter.

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Aug
2005

"Obstructive uropathy" is a generic term which combines different diseases in infants and childhood. Both the upper and lower urinary tract may be affected. Diseases of the urinary tract can cause an intrinsic obstruction.

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Mar
2005

We evaluated the results of direct nipple ureteroneocystostomy technique in adults with primary obstructed megaureter.
Five patients with a mean age of 32.5 years had a total of 6 primary obstructed megaureters with complaints of flank pain.

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Dec
2004

The purpose of this study was to design an alternative imaging technique to CT urography in patients with high-grade urinary tract obstruction, with or without impaired renal function, that uses the superior resolution of MDCT and avoids IV contrast material administration.
Antegrade MDCT pyelography is an alternative imaging technique to CT urography in patients with high-grade urinary tract obstruction with or without impaired renal function. It enables accurate diagnosis of the level of obstruction, as well as its etiology, including nephroureterolithiasis, urothelial tumors, primary congenital megaureter, uretero-pelvic junction stenosis, ureteral edema, ureteral stricture, retroperitoneal fibrosis, and pelvic lymphadenopathy.

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Dec
2002

To report two cases of bladder exstrophy managed successfully by augmentation ureterocystoplasty (UCP) together with bladder neck surgery and continent diversion.
Two boys, age 5 and 1 years respectively, had augmentation UCP. The left refluxing megaureter was used in the first case together with bladder neck reconstruction.

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Dec
2002

Congenital anomalies of the lower urinary tract are a significant cause of morbidity in infancy. Radiologic investigation is an important source of clinical information in lower urinary tract disorders but should not inconvenience the patient, expose the patient to unnecessary radiation, or delay surgical correction. In pediatric patients with suspected underlying urologic structural anomalies, screening ultrasonography is commonly the initial diagnostic study.

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Feb
2002

Presented is the diagnostic and therapeutic management of the primary obstructed megaureter (POM). 42 patients presented with 53 ureteral units (UU) of POM (5 females, 37 males, 36 neonates and 6 children aged 3 to 8 years). Of the 53 megaureters 10 UU (19%) were on the right and 27 UU(51 %)were on the left.

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Jun
2001

To assess the value of renal scintigraphy with 99mTc-dimercaptosuccinic acid (DMSA) in predicting functional recovery after the surgical relief of obstructed kidneys in children. Patients and methods Forty-three children underwent surgery to relieve upper urinary tract obstruction; 37 had pelvi-ureteric junction obstruction and six had vesico-ureteric junction obstruction. The indication for surgery was a combination of an obstructed renogram with symptoms of either pain or pyelonephritis.

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Dec
1969

Documentation of unique kidney renal function early in pregnancy can be helpful in defining prenatal management and therefore in improving prognosis. Antenatal diagnosis of a solitary kidney was performed at 20 weeks' gestation in a foetus with a 1,7 chromosome translocation. Because of the decreasing renal function and the increasing pelvic dilatation, an early in utero stenting was placed at 23 weeks' gestation.

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Dec
2000

To verify the utility of diuretic renography using 99mTc-MAG3 in the evaluation of the urinary tract obstruction in patients with prenatal diagnosis of hydronephrosis. In a neonate with upper urinary tract dilatation, it is difficult to differentiate a true obstruction from a dilated non-obstructed system.
The retrospective study (january 1993-december 1998) included 40 consecutive patients selected from 181 newborns with a prenatal diagnosis of hydronephrosis.

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Apr
2000

Congenital obstructive megaureter (COMU) may be unilateral or bilateral and may present in later years of life. If the obstruction is not relieved in good time, deleterious effects on the proximal ureter and kidney are well known. Stones may complicate the situation further.

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Feb
2000

To assess the role of the renal resistive index ratio (RIR) in discriminating equivocal upper urinary tract dilatation in children, and thus in establishing the need for surgery, in comparison with traditional diagnostic tools.
The study comprised 40 children with unilateral hydronephrosis unrelated to vesico-ureteric reflux, posterior urethral valves, megaureter or a duplex system. In all patients one or more of the following 'indices of obstruction' were positive; an anteroposterior renal pelvic diameter of >20 mm, a half-time diuretic 'washout' (T/2) of > 20 min, a separate renal function of < 40%, and symptoms of obstruction (pain, sepsis).

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Dec
1998

The authors report their experience on 22 neonates (14 males and 8 females) with primary megaureter. In 18 patients a prenatal diagnosis was available, in the other four the diagnosis was suspected during a neonatal ultrasound screening. The dilatation involved the right ureter 7 times and the left 13 times, in 2 patients it was bilateral.

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