Megaureter

As megaureter (syn. Megaloureter ) is called a congenital ureter malformation. Can occur on one or both sides. The megaureter impressed by massive expansion and usually also increased tortuosity ( as a sign of increase in length ). The reason is a replacement of the smooth Harnleitermuskulatur by connective tissue, which leads to neuromuscular dyskinesia and thus halt the substantial physiological peristalsis. A megaureter may be a cause of hydronephrosis and a vesicoureteral reflux (Upgrade of urine from the bladder into the ureter during urination ) and thus the corresponding consequences.

The acquired Harnleitererweiterung (syn. Harnleiterdilatation ) is called hydroureter. The reason for this is a urinary obstruction.

Different types of Megaureters

An extension of the efferent urinary system can - but need not - be associated with an obstruction. In some cases, the expanded urethra does not damage the kidneys. Similarly, not all children with prenatally diagnosed Megaureteren necessarily symptoms that are associated with the Harnleitererweiterung.

Diagnosis

Today, most Megaureteren be found already in the context of prenatal diagnosis.

The prenatal ultrasound will show a urine transport in the fetus. Since the megaureter urinary tract infections or obstruction of the kidney may cause the leads in time to a kidney injury, an accurate diagnosis and careful monitoring are necessary.

Sonography

Ultrasonography is a simple and painless procedure that represents the shape of the kidneys, bladder and ureters. The investigation is highly sensitive.

Urography

In Urography the ureters provide significantly expanded and tortuous dar.

Miktionscystourethrogramm / Miktionsurosonographie

A Miktionscystourethrogramm / Miktionsurosonographie is performed to determine a vesicouretero -renal reflux. A small catheter is introduced thereto through the urethra into the bladder, or directly using a needle into the bladder is then filled via the contrast medium into the bladder. Is there a reflux, one can determine these radiologically ( = Miktionscystourethrogramm ) or more recently with the ultrasound ( = Miktionsurosonographie ). The contrast agent is then found as the child urinates in the urethra or the renal pelvis as a sign of a back-flow of urine from the bladder in the upper urinary tract.

Therapy

If the tests show an obstruction or impaired renal function, surgical treatment is indicated. The typical operation for the correction of Megaureters is the Harnleiterneueinpflanzung.

Usually, the operation is not performed before the age of one year, unless the child is already showing a deterioration of renal function or you have any febrile urinary tract infections.

Children with a megaureter require antibiotic prophylaxis at the time of observation, that is, up to the date on which either the self-healing of Megaureters occurs or until the date on which the supply is operational. The operation consists in an enlarged strips cut above the one Harnleiterneueinpflanzung done. This is either extravesikal, ie without opening the bladder, or transvesikal, so made ​​under the opening of the bladder. If there is an obstruction, it will be removed.

Harnleitererweiterung often remains even after the operation, so that it may be necessary to verify the success of the operation. For this purpose, it may be necessary to perform a re- Miktionscysturethrographie or Miktionsurosonographie and renal scintigraphy. A re- obstruction may occur again in about 5 % of cases.