DOI: https://doi.org/10.26641/2307-5279.23.4.2019.187226

Our treatment experience in children of the first year of life with megureter

V.A. Degtyar, L.N. Harytonyuk, M.V. Boyko, A.V. Obertinsky, A.A. Ostrovskaya, K.V. Shevchenko

Abstract


Introduction. Megaureter one of the most challenging issue of childhood urology. Diversity and high prevalence of malformations of the ureter, the severity of the emerging complications require early diagnosis and determination of treatment tactics.

Goal. Further improvement of diagnostic criteria and evaluation of treatment outcomes, identification of the benefits of different treatments.

Material and methods of research. The screening of the megaureter includes ultrasound scan examination kidney and bladder with doppler renal vessels and diuretic loading, excretory urography and voiding cystourethrogram. The results of diagnosis and treatment of 298 patients with severe forms of ureteric pathology, of which up to 1 year of 106 children, were dominated boys 62.6%. Refluxing megaureter was found in 118 patients (39.7%), Nonobstructed/nonrefluxing in 71 patients (23.8%) and obstructive megaureter was 109 patients (36.5%). The factor of violation of urodynamics among obstructive uropathies in 37 children was ureterocele and in 72 patients had stenosis or stricture vesicoureteral junction.

Research results and their discussion. The long-term treatment of obstructive megaureter in 91.4% has given a positive result. In the treatment of functional Nonobstructed/nonrefluxing megauereter, the use of conservative and semi- conservative treatment methods gave a positive result and only 28.7% patients needed surgical treatment. Treatment of reflux megaureter included the use of different treatments. The effectiveness of the endoscopic method was 67.7%, and the rest of the children who did not have effect of endoscopic treatment performed reconstructive surgical interventions. We used transtrigonal ureteric (Cohen) reimplanation, intravesical technique Politano Leadbetter, extravesical detrusorraphy technique Lich-Gregoir.

Conclusions. Treatment of infants with congenital megaureter is a complex problem and includes the benefits of applying conservative and semi-conservative and treatment methods. In the early stages of treatment, the age of the child and the functional capacity of the bladder are the basis for determining the term of operative reconstructive treatment. The justification of the method of reconstructive surgical intervention is determined individually. They are used both methods reconstructive surgical intervention - extra and intrabladder neo-cystureteroneostomy.

Keywords


children; megurether; treatment

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