Mp55-01 Comparison of Two Different Approaches in the Management of Infants With Primary Obstructive Megaureters and Their Long-Term Outcomes

You have accessJournal of UrologyPediatrics IV (MP55)1 May 2024MP55-01 COMPARISON OF TWO DIFFERENT APPROACHES IN THE MANAGEMENT OF INFANTS WITH PRIMARY OBSTRUCTIVE MEGAURETERS AND THEIR LONG-TERM OUTCOMES N. Manu Kaushik, Tarun Javali, and Neehar Patil N. Manu KaushikN. Manu Kaushik , Tarun JavaliTarun Javali , and Neehar PatilNeehar Patil View All Author Informationhttps://doi.org/10.1097/01.JU.0001008616.01808.0f.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is paucity of literature in the management of infants (<1 year of age) with obstructive primary megaureters undergoing either upfront primary repair (PR) or delayed staged repair (DSR). We have aimed to compare these different approaches in the management of these infants with unilateral primary obstructive megaureters and their long-term outcomes. METHODS: Our study was a retrospective analysis of a prospectively maintained data base between 2006 to 2022. Infants with unilateral primary obstructive megaureter, were included. The infants were divided into 2 group i.e. those who underwent an upfront extravesical ureteric reimplantation (PR), and those who initially underwent a low-end cutaneous ureterostomy during infancy followed by takedown of ureterostomy and intravesical ureteric reimplantation after 1 year of age (DSR). All the children included were followed up annually on 1st year and 3rd year after their definitive repair with an ultrasound of the renal system, diuretic renogram, estimated glomerular filtration rate and an assessment of voiding dysfunction if present. Failure was defined as persistent obstructive pattern on renogram with worsening differential renal function or presence of high grade reflux with recurrent breakthrough urinary tract infection; both of which necessitated a redo re implantation following the definitive surgery. RESULTS: Our study included 34 infants, of which 18 underwent PR and 16 underwent DSR. Urinary tract infections were the commonest presenting symptom amongst both groups i.e., >50%. The post operative complication rate was 11% in PR group and 31% in DSR group. One child amongst each of the groups underwent a redo reimplantation (5.8%). At the end of the 3rd year follow up, there was a significant reduction in the grade of hydronephrosis, improvement in the differential function with no evidence of obstruction and improvement in the estimated glomerular filtration rate amongst all in both groups which was statistically significant i.e., p<0.05. The success rate was 94.4% amongst those who underwent PR and 93.75% amongst those who underwent DSR. The mean follow up was 9.7 years amongst those in PR and 9 years amongst those in DSR. CONCLUSIONS: Primary extravesical ureteral reimplantation has equivalent long-term outcomes to cutaneous ureterostomy followed by a delayed ureteral reimplantation amongst infants with primary obstructive megaureters, hence it may be considered as the preferred line of management amongst the infantile population. Source of Funding: No funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e916 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information N. Manu Kaushik More articles by this author Tarun Javali More articles by this author Neehar Patil More articles by this author Expand All Advertisement PDF downloadLoading ...