Obstructed megaureters may be managed with temporising stents, cutaneous ureterostomies, or in older children with ureteral reimplantation (usually if the child is over one year of age). Cutaneous ureterostomies have risks of stomal stenosis, infection and leakage problems over nappies with cosmetic disadvantages. In bilateral cases ureterostomies are not recommended as the bladder is taken out of the urinary flow circulation. Ureteral stents can cause pain, can migrate and are generally difficult to place in the very small infant. This paper describes a series of 16 patients with obstructing megaureters in 19 ureters treated with an end to side refluxing ureterocystostomy (initially described in 2005) as a temporising measure until the children were old enough for a formal anti refluxing ureteral reimplant after one year of age. Eleven had hydronephrosis and five had sepsis. Three had duplex systems. The average age of the procedure was five months with the average interval until the definitive reimplant being 16 months. The refluxing reimplant was successful in relieving the obstruction in all cases. The authors conclude that this method of relieving the obstruction is feasible, successful and should be the initial treatment in infant / neonatal obstructed megaureters. 

Refluxing ureteral reimplantation: a logical method for managing neonatal UVJ obstruction
Kaefer M, Miserie R, Frank E, et al.
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Henrik Steinbrecher

Southampton University Hospital NHS Trust

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