Megaureter

Megaureter je deskriptivni pojam koji označuje dilatirani mokraćovod. Definira se kao svaki retrovezikalni promjer uretera jednak ili veći od 7 milimetara, od 30.tjedna trudnoće na dalje. Klasifikacija se temelji na prisutnosti opstrukcije ili refluksa te prema uzroku. Četiri su kategorije megauretera: refluksni, opstruktivni, refluksni s opstrukcijom i nerefluksni/neopstruktivni, a svaki od njih s obzirom na uzrok može biti primarni i sekundarni. Megaureter se javlja nešto češće kod dječaka i to više na lijevoj strani. Primarni megaureter je drugi najčešći uzrok hidronefroze. Megaureter se obično detektira prenatalno kao slučajan nalaz. Djeca obično nemaju simptoma, a ako oni postoje onda su to obično rekurentne urinarne infekcije, bolovi u trbuhu, neobjašnjive temperature itd. Dijagnoza se obično potvrđuje ultrazvukom, a danas postoji i novija UZV metoda nazvana ceVUS koja je slična MCUG samo ne koristi ionizirajuće zračenje. Ako je potrebna daljnja obrada onda se rade još također i dinamička scintigrafija bubrega, MRU i fMRU. Inicijalno liječenje svih vrsta megauretera je konzervativno. Indikacije za kirurško liječenje su masivna hidroureteronefroza, progresivni gubitak bubrežne funkcije i neuspješno konzervativno liječenje. Postoje brojne metode kirurškog liječenja. Kod djece starije od jedne godine, reimplantacija uretera je metoda izbora liječenja. U početku se ona radila otvorenim pristupom koji je tehnički bio teško izvediv. S vremenom se razvijaju manje invazivne metode s boljim postoperativnim ishodima i smanjenom stopom komplikacija. Te metode uključuju laparoskopsku reimplantaciju uretera transvezikalnim pristupom i endoskopsku dilataciju balon kateterom. Od privremenih kirurških metoda tu su insercija dvostruke J-proteze, refluksna reimplantacija i postavljanje ureterostome. Megaureter is a descriptive term denoting dilated ureter. It is defined as any retrovesical diameter of the ureter equal to or greater than 7 millimeters, from the 30th week of pregnancy onwards. Classification is based on the cause and presence of obstruction or reflux. There are four categories of megaureters: reflux, obstructive, obstructive with reflux, and non-reflux / non-obstructive, and each of them can be primary or secondary, depending on the cause. Megaureter occurs more often in boys and is more commonly located on the left side. The primary megaureter is the second most common cause of hydronephrosis. Megaureter is usually detected prenatally as a random finding. Children are usually asymptomatic, and if symptoms exist, the patients usually present with recurrent urinary tract infections, abdominal pain, unexplained fever etc. The diagnosis is usually confirmed by ultrasound. Today there is a newer ultrasound method called ceVUS, which is similar to MCUG, but it does not use ionizing radiation. If further diagnosis is needed, then dynamic renal scintigraphy, MRU and fMRU are also performed. Initial treatment of all types of megaureters is conservative. Indications for surgical treatment are massive ureterohydronephrosis , progressive loss of renal function, and unsuccessful conservative treatment. There are numerous methods of surgical treatment. In children older than one year, ureteral reimplantation is the method of choice. Initially, it was done with an open approach that was technically difficult to perform. Over time, less invasive methods were developed with better postoperative outcomes and a reduced complication rate. These methods include laparoscopic reimplantation of the ureter by transvesical approach and endoscopic balloon dilatation. Temporary surgical methods include double J-stent insertion, reflux reimplantation, and ureterostomy placement.