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Ureterovesical Junction Obstruction

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Pediatric Urology

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Abstract

Congenital dilatation of the ureter (megaureter) in the absence of primary vesicoureteric reflux or infravesical obstruction may be due to ureterovesical junction obstruction. However, in the majority of such megaureters, relevant obstruction will not be present, and there will be high rate of spontaneous regression without any renal impairment or clinical symptoms. Therefore, conservative management is generally considered a safe initial approach. The clinical challenge is to be able to differentiate the megaureters, which will need a surgical approach. Reimplantation with ureteral remodeling has been the established treatment for progressive or persistent primary obstructive megaureter associated with significant obstruction and/or infection. There have been some innovative strategies like JJ stent placement and endoscopic intervention to the ureterovesical junction. Several reports of these new innovative approaches failed to identify a selection criterion. Given the high complication rate, it seems that the use of such approaches in infancy should be limited to very select patients. There is a growing tendency toward minimally invasive surgery and the application of improved laparoscopic and robotic techniques to megaureter surgery as well.

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Authors and Affiliations

  1. Division of Pediatric Urology, Department of Urology, Hacettepe University, Sihhiye, Ankara, 06100, Turkey

    Serdar Tekgul MD, FEAPU

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  1. Serdar Tekgul MD, FEAPU
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Correspondence to Serdar Tekgul MD, FEAPU .

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Editors and Affiliations

  1. Pediatric Surgery, S. Orsola-Malpighi University Hospital, Bologna, Bologna, Italy

    Mario Lima

  2. Pediatric Urology, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy

    Gianantonio Manzoni

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Tekgul, S. (2015). Ureterovesical Junction Obstruction. In: Lima, M., Manzoni, G. (eds) Pediatric Urology. Springer, Milano. https://doi.org/10.1007/978-88-470-5693-0_10

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  • DOI: https://doi.org/10.1007/978-88-470-5693-0_10

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