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PAEDIATRIC UROLOGY

5.3.2 Megaureter

According to the official international classification, megaureters are subdivided into primary and secondary, obstructive and/or refluxive and non-refluxive, non-obstructive. Treatment of the refluxive megaureter is dealt with in the section on vesicoureteral reflux (VUR). The diagnostic evaluation is the same as in unilateral hydronephrosis. The degree of obstruction and the split renal function is determined by renal scintigraphy and IVU.

In view of equivalent results of surveillance, surgical intervention based only on the excretory urogram is now rare. With spontaneous remission rates of up to 85% in primary obstructive megaureters, high drainage by means of Sober's or ring-ureterocutaneostomy is no longer justified.

Operative ureterocystoneostomy according to Cohen, Politano-Leadbetter or the Psoas-Hitch-technique can be considered as an operative measure. Indications for surgical treatment of megaureter are recurrent infections under prophylactic antibiotic medication, deterioration of split renal function, reflux persisting for more than 1 year under prophylaxis and significant obstruction.