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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 1  |  Page : 160-162
Giant megaureter presenting as cystic abdominal mass


M.Y. Hospital, Indore, India

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Date of Web Publication8-Jan-2010
 

How to cite this article:
Saurabh G, Lahoti BK, Geetika P. Giant megaureter presenting as cystic abdominal mass. Saudi J Kidney Dis Transpl 2010;21:160-2

How to cite this URL:
Saurabh G, Lahoti BK, Geetika P. Giant megaureter presenting as cystic abdominal mass. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Sep 28];21:160-2. Available from: http://www.sjkdt.org/text.asp?2010/21/1/160/58796
To the Editor,

Megaureters are an infrequent ureteral abnor­mality, and optimal imaging can diagnose it antenatally as well. However, undiagnosed me­gaureters may progress to occupy the whole abdomen, and impose diagnostic difficulties.

A 7-year-old girl presented with a massively distended abdomen. She had a history of slowly progressive enlargement of the abdomen since birth. There was no history of any other com­plaints except for few episodes of burning mic­turation. Physical examination revealed an intra­abdominal lump occupying the right lumbar and iliac region, 10cm by 8cm in size, globu­lar, cystic, with smooth surface and rounded margins, moving with respiration, with slight mobility in both axes, and nontender. Routine blood examinations revealed normal peripheral blood count, serum urea, and creatinine level. Urine examinations revealed the presence of urinary infection, which was managed by anti­biotics. Ultrasonography (USG) showed a huge cystic mass occupying the entire right flank region. Right kidney and ureter could not be vi­sualized separately. Contrast enhanced CT scan of the whole abdomen revealed a large, multi­cystic mass occupying almost the complete mid and lower abdomen with no contrast en­hancement [Figure 1]. Surgical exploration was planned. Intra-operatively, a hugely dilated ser­pinguous right ureter was found with atrophic right kidney constricted right uretero vesical junction (UVJ) [Figure 2], and[Figure 3]. Left kidney, ureter and VUJ were all normal.

Megaureter is defined as an enlarged or a di­lated ureter with or without dilatation of the re­nal pelvis and calyces. Megaureter is a spora­dic or familial disease, [1],[2],[3] where males are more commonly affected than females, [4],[5] and the commonest cause is bladder outlet obstruc­tion. [6] In primary obstructive megaureter, the obstruction is at or just above the uretero­vesical junction (UVJ) and is most commonly the result of an adynamic juxtavesical segment of the ureter that fails to effectively propagate urine flow. [7],[8],[9] Bilateral involvement is present in 20% of the cases with a male-to-female ra­tio of 4:1. The left side is more commonly affected. On the other hand, secondary obs­tructive megaureter results from a functional ureteral obstruction associated with elevated bladder pressures as with posterior urethral valve (PUV) or neurogenic bladder (NGB), that impede ureteral emptying. Primary refluxing megaureter occurs due to a failure of the anti­reflux mechanism at the UVJ, while secondary refluxing megaureter occurs secondary to PUV and NGB when elevated bladder pressure cau­ses incompetence of the UVJ. It is charac­terized by high rates of urine formation as in diabetes insipidus or infection, and ureters that remain wide open after spontaneous cessation of VUR. Megaureter may be associated with unilateral renal agenesis, complete or incom­plete duplex system, ectopic kidney, contrala­teral cystic and dysplastic kidney, horseshoe kidney, or Hirschsprung's disease. [5],[10],[11] Imaging studies are useful in the diagnosing the cases of megaureter such as ultrasound, voiding cys­tourethrogram (VCUG), diuretic nuclear reno­graphy, intravenous pyelogram (IVP), contrast enhanced CT, and MRI. Important differential diagnoses with megaureters include mesenteric and adnexal masses in females and dilated bo­wel loops. Surgical therapy is indicated for the megaureters that are secondary to severe VUR or obstruction, and it is usually managed with ureteral reimplantation. Occasionally, nephro­ureterectomy may be indicated when the func­tion of the kidney is severely impaired.

 
   References Top

1.Mebust WK, Forest JD. Vesicoureteral reflux in identical twins. J Urol 1972;108(4):635-6.  Back to cited text no. 1      
2.Mogg RA. Familial and adult reflux. Birth Defects 1977;8(5):365-6.  Back to cited text no. 2      
3.Stephens FD, Joske RA, Simmons RT. Mega­ureter with vesicoureteric reflux in twins. Aust NZJ Surg 1955;24:192.  Back to cited text no. 3      
4.Hanna MK, Jeffs RD. Primary obstructive mega­ureter in children. Urology 1975;6(4):419-27.  Back to cited text no. 4      
5.Wood BP, Ben-Ami T, Teele RL, Rabinowitz R. Ureterovesical obstruction and megaloureter: Diagnosis by real-time ultrasound. Radiology 1985;156(1):79-81.  Back to cited text no. 5      
6.Hobbins JC, Romero R, Grannum P, Berkowitz RL, Cullen M, Mahoney M. Antenatal diag­nosis of renal anomalies with ultrasound, I: Obstructive uropathy. Am J Obstet Gynecol 1984;148(7):868-77.  Back to cited text no. 6      
7.Gosling JA, Dixon JS. Functional obstruction of the ureter and renal pelvis: A histological and electron microscopic study. Br J Urol 1978;50:145.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Tokunaka S, Koyanagi T. Morphologic study of primary nonreflux megaureters with particular emphasis on the role of ureteral sheath and ureteral dysplasia. J Urol 1982;128(2):399-402.  Back to cited text no. 8      
9.Tokunaka S, Koyanagi T, Tsuji I. Two infan­tile cases of primary megaloureter with uncom­mon pathological findings: Ultrastructural study and its clinical implication. J Urol 1980;123 (2):214-7.  Back to cited text no. 9      
10.Sant GR, Barbalias GA, Klauber GT. Conge­nital ureteral valves: An abnormality of ure­teral embryogenesis. J Urol 1985;133(3):427-31  Back to cited text no. 10      
11.Swenson O, Macmahon E, Jaques WE, Camp­bell JS. A new concept of the etiology of of megaloureters. N Engl J Med 1952;246(2):41­6.  Back to cited text no. 11      

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Correspondence Address:
Garge Saurabh
M.Y. Hospital, Indore
India
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PMID: 20061716

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