Primary obstructive and refluxing Megaureter in children: mid-term outcome of surgical management in a retro-prospective descriptive case series

Context and objectives. In African countries, where primary megaureter is often diagnosed late due to lack of technical facilities, little is known about the functional outcome of therapeutic management of this frequent obstructive uropathy. The aim of the present study was to describe the medium-term outcome of the management of primary megaureter in children, and to identify functional sequelae. Methods. This was a descriptive & retro-prospective series of cases of primitive megaureter operated on with a minimum one-year setback, over an eight-year period (2015 to 2022) in the Unit of Surgical Pediatry at the Centre Hospitalier Universitaire (CHU) Hassan II in Fès, Morocco. The primary endpoint was recovery of individual renal function as evidenced by functional renal scintigraphy. Results. A total of 22 patients (male 81.8%, mean age 37.7 months on admission) were enrolled. Involvement was bilateral in 7 children, for a total of 29 renal units. Of these, 22 were obstructive and 7 were refluxing. Surgical management included emergency ureterostomy, re-implantation or total nephrectomy. On renal scintigraphy, more than half of the patients operated on according to Cohen progressed to improved renal function, compared with just over a quarter for the Lich-Gregoir technique, despite the good clinical result and improved ureteral dilatation on ultrasound. Conclusion. Emergency ureterostomy improves renal function in 50% of cases, including refluxing megaureters. However, a non-negligible proportion of cases progress to a continuation of functional impairment on scintigraphy at the last follow-up. Received: January 21st, 2024 Accepted: April 2nd, 2025 https://dx.doi.org/10.4314/aamed.v18i3.16