Temporary derivation of the urinary tract, as the method of choice for the treatment of obstructive megaureter in newborns

Regional Children Clinical Hospital, Chelyabinsk, Russia
South Urals State Medical University, Chelyabinsk, Russia, Ministry of Health of Russian Federation

Introduction. 

The need for temporary drainage of the urinary tract with obstructive megaureter in newborns is due to a number of reasons: low bladder capacity, severe ureteral dilatation, and ab-rupt suppression of kidney function, which makes it difficult and sometimes impossible to per-form ureterocystanastomosis. There are various types of reconstructive "Y" - shaped ureterocu-taneostomy. For their creation, ureter resection and ureteroureteroanastomosis are required.

Objective. 

To determine the effectiveness of temporary drainage of the urinary tract in case of obstructive megaureter in newborns, by performing a suspension (parietal) ureterocutaneostomy.

Materials and methods.

 During the last 10 years, 121 infants with obstructive megaureter were the subject of the study: 87 (72%) of them were boys and 34 (28%) were girls. Bilateral megaureter was detected in 19 (16%) patients. In all patients megaureter was diagnosed in uterus. The main diagnostic method in the early postnatal period was complex ultrasound investigation, intravenous urography, diuretic sonography, Doppler sonography of the renal vessels, dynamic nephroscintigraphy. The preserved parenchyma and satisfactory function of the affected kidney in 9 newborns made it possible to continue dynamic monitor-ing or delay the surgical stage of treatment. A sharp decline in kidney function was detected in 10 new-borns, and all showed marked retentional changes in the ureter. Percutaneous nephrostomy was per-formed on 3 newborns due to intoxication caused by pyelonephritis. In 16 patients, a “Y” -shaped ureter-ocutaneostomy was performed. The method of suspension ureterocutaneostomy was chosen in 13 new-borns. Suspension ureterocutaneostomy allows for therapeutic and diagnostic interventions in both areas of the ureter, while the closure of the stoma does not require extensive resection of the ureter, the length of which is so important in subsequent plastic surgery.

Results. 

The state of the function of the kidney after the drainage operation was assessed within 3-6 months for the need to make a decision on the subsequent reconstructive operations. Kidney function improved and ureteral retention decreased in 9 patients. These patients underwent ureterocystanastomosis surgery according to the Cohen method in modification with subsequent closure of the stoma and ureteroureteroanastomosis on the internal stent in 1-2 months. Moreo-ver, modeling of the width of the ureter was not performed. In 4 patients, the function did not recover within 6 months of follow-up. Given the absence of megaureter complications, surgery was postponed to a later date. After transvesical reconstructive surgery on the ureter, control ex-amination was performed in 6-12 months. The follow-up analysis of the treatment showed that the majority (72%) of the children had satisfactory results.

Conclusions. 

Our experience confirms the opinion of the need for temporary drainage of the uri-nary tract in newborns as a stage of reconstructive surgical treatment of an obstructive megaure-ter. Suspension ureterocutaneostomy technology does not require extensive resection of the ure-ter when closing. The advantages of this method of reconstructive ureterocutaneostomy are ob-vious: the operation is less traumatic, with a minimum of complications.