MEGAURETER

DR.MOHAMED ASHRAF MOSTAFA

MS.FRCS
 URETEROVESICAL JUNCTION

3 Features help the antireflux

mechanism
•Fixation of the ureter to the trigonal
muscle.
•Support of the detrusor posteriorly
•Compressibility of the ureter.
 MEGAURETER
Ureteral dilatation in
absence of vesical
dysfunction or
urethral obstruction .
Males > females .
Lt. > Rt.
 MEGAURETER

Refluxing Obstructed Non refluxing

Non obstructed

Primary Secondary Primary Secondary Primary Secondary

Congenital PUV PUV Idiopathic Diabetes
refluxing Adynamic
Neurogenic Neurogenic Insipedus
megaureter Segment
bladder Bladder Infection
Intrinsic obst.
Extrinsic obst. Residual
Post-obst.
dilatation
 MEGAURETER

Megaureter Refluxing Adult primary megaureter

with v.u.reflux. megaureter
with PUV
Adult Megaureter
 MEGAURETER
MANAGEMENT
Conservative .

Surgical .
Pain.
UTI .
Renal impairment.
 U.V.Reimplantation
Techniques
Transvesical.
Extravesical.
Combined.
Suprahiatal or infrahiatal .
URETEROVESICAL REIMPLANTATION
TECHNIQUES
Direct anastomosis.
Tunnel implantation .
Cuff nipple implantation .
Bladder flap procedure .
Bladder-elongation psoas hitch procedure.
 U.V.Reimplantion
Techniques
Stefanovic & coworkers in 1991 addressed the
need to prevent reflux in the adult undergoing
Ureteral reconstruction.
In a retrospective review of adults having
undergone a ureteroneocystostomy, they
concluded there was no difference in the
preservation of renal function or risk of stenosis
with antireflux versus reflux procedures .
Whether a non refluxing anastomosis decreases
the risk of pyelonephritis in an adult is uncertain.
 CASE PRESENTATION
38 Years old patients presented with
repeated left flank pain since long
duration.
No history of bilhariziasis or T.B.
U/A : normal finding.
CBC, BUN , s. creatinine : normal.
KUB : No R.O.calculi .
U/S : Lt. back pressure changes.
IVU
 Clinical Course
The patient underwent cystoscopy, during
which ureterocele was excluded .
On table retrograde study showed a
stenotic segment in distal end of Lt.
ureter .
Balloon dilatation was performed .The
internal stent was removed after six weeks
Balloon Endodilation
POST ENDODILATION
IVU
Exposure of Ureter
Exposure of Ureter
Exposure of Ureter
 U.V.Reimplantation
split cuff-nipple technique
 U.V.Reimplantation
Split cuff-nipple implantation
Post-Op. cystoscopic view
Post Op.
Ascending Cystography
Post Op.
IVU
 Pre & Post - Op

Pre-Op
15 min. Post void

Post-OP
15 min.

Post void