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Complications and long-term outcome of primary obstructive megaureter in childhood

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Abstract

We assessed the clinical outcome of 49 children with 56 primary obstructive megaureters (POM) treated with the primarily conservative approach recommended by the 2001 German consensus guidelines. POM occurred more often in boys (71%) and on the left side (67%). Forty-three POM (77%) were treated conservatively. Four kidneys underwent immediate surgery and nine of 52 kidneys managed primarily conservatively worsened subsequently, requiring surgery. Urinary tract infections (UTI) were the most common complication (mean 1.3 per patient), with frequent hospital admission (45%). During the first year of life, the incidence of UTIs was 55% less during prophylactic antibiotic treatment (0.94 vs.0.42 UTIs per year, p < 0.05). Spontaneous regression occurred in 80% of POMs with dilated non-obstructive renogram, but in <20% with intermediate or relevant obstruction. All megaureters with <8.5 mm sonographic diameter regressed, but none over 15 mm. Eight patients had a poor outcome (partial kidney function <40% (n = 6), renal atrophy (n = 3)), but in seven of the patients, these findings were already present postnatally. In summary, the long-term outcome of POM appears favorable with mainly conservative treatment. UTI as the most common complication was 55% lower with antibiotic prophylaxis in infants. Adverse outcome was more closely related to congenital kidney hypoplasia than to degree of obstruction.

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Author notes

  1. Charlotte Gimpel

    Present address: Center for Child and Adolescent Medicine, University Hospital Freiburg, Freiburg, Germany

Authors and Affiliations

  1. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany

    Charlotte Gimpel, Liuda Masioniene, Burkhard Tönshoff & Franz Schaefer

  2. Department of Urology, University Hospital Heidelberg, Heidelberg, Germany

    Nenad Djakovic

  3. Division of Pediatric Radiology, Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany

    Jens-Peter Schenk

  4. Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany

    Uwe Haberkorn

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  1. Charlotte Gimpel
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  2. Liuda Masioniene
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  7. Franz Schaefer
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Correspondence to Franz Schaefer.

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Gimpel, C., Masioniene, L., Djakovic, N. et al. Complications and long-term outcome of primary obstructive megaureter in childhood. Pediatr Nephrol 25, 1679–1686 (2010). https://doi.org/10.1007/s00467-010-1523-0

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  • DOI: https://doi.org/10.1007/s00467-010-1523-0

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