Introduction

Surgical intervention for primary non-refluxing megaureter (PNM) is indicated in patients with worsening upper tract dilatation or recurrent urinary tract infections (UTI). In young children with significant discrepancy between a small bladder and large ureter caliber, a side-to-side refluxing ureterocystostomy can be considered. The objective of this study was to describe the natural history and long-term outcomes after ureterocystostomy in patients with PNM.

Methods

Patients referred to our institution for antenatal hydronephrosis were considered. We included patients who underwent ureterocystostomy with PNM, defined as hydroureteronephrosis with dilatation > 7mm and absent vesicoureteral reflux. We excluded patients with other etiologies for upper tract dilatation. We assessed for surgical outcomes, complications, culture-proven UTI, and resolution of hydroureteronephrosis.

Results

Among 183 patients diagnosed with primary megaureter, 47 (25.6%) underwent primary ureterocystostomy for obstruction. The median age of presentation, surgery, and follow-up was 2, 8, and 43 months, respectively. A total of 7 patients developed 30-day complications (Clavien-Dindo - Grade 1: 2 developed retention, Grade 2: 5 developed UTI in the short post-o, Grade 3-5: None). Over long-term follow-up after operation, 11 (23%) patients experienced breakthrough UTIs and 7 (15%) required ureteral reimplant or takedown for recurrent UTI. All patients had pre-operative hydronephrosis (median APD 18, high-grade in 96%) and 40 patients (85%) had hydroureter with a median ureter dilatation of 17 mm. As shown in Figure 1, there was decrease in both the proportion of patients with high-grade hydronephrosis (median APD 11, high-grade in 50%) and hydroureter with median dilatation of 13 mm.

Conclusion

Side-to-side refluxing ureterocystostomy is a safe and feasible option for PMN. The short-term complication rate is low, and while 15% of patients required surgical intervention for reflux, the majority of patients had resolution of upper tract dilatation by last follow-up.