Follow-up a medio e lungo termine in bambini con megauretere non refluente: valutazione critica

Objectives - The purpose of our research was to assess the natural history of the non-refluxing, non-obstructive megaureter by means of a medium and long term follow-up. Methods - From 1992 to 2003 we observed 48 infants (37 males and 11 females) with a non-refluxing megaureter. In 58.3% of the cases it was already diagnosed through intrauterine ultrasound screening (US) during pregnancy, in 37.3% through neonatal ultrasound screening and in 4% because of urinary tract infection. In 43.7% of the cases the megaureter was on the left side, in 25% on the right side and it was bilateral in 31.3% on a total of 63 dilated units. All patients underwent: US, mintional cistouretrography (all negative for RVU), and renal dynamic scintigraphy. The scintigraphy showed that 81.2% of the patients did not have any obstruction and had a good and stable functionality, whereas in 16.6% the scintigraphic pattern resulted positive for obstruction but showed normal glomerular filtrate, except for 2.2%. Results - 80.4% of the children showed improvement, i.e. the reduction of 1st degree hydronephrosis; they were treated without surgery for an average period of 46.7 months (range 8-126, average 46). 19.6% of the cases underwent surgical treatment of re-implantation and re-modelling/refashioning: 7 patients because they had an obstructive megaureter and 2 patients since renal ultrasound showed a progressive dilation of the hydro-ureter-nephrosis. Conclusion - With our research we sustain that the treatment without surgery of the non-refluxing megaureter diagnosed during the prenatal period in asymptomatic newborn children is safe and effective.