A clinical case of surgical treatment of a 10-year-old girl with megaureter of the single kidney

Abstract

   Editrial comment. The described long-term multi-stage surgical treatment – performed at the child's place of residence was not adequate and was the threat of losing the only kidney. Management of patients with a non-reflexing form of megaureter, especially in the neonatal period, requires the assessment of not only the state of the kidney and ureter, but also the state of the bladder, in order to exclude the bladder-dependent form of megaureter. Proximal ureterocuteniostomy, especially of a single kidney, should not be used without a preliminary, full-fledged urological examination. Children with complex malformations of the urinary system should be promptly consulted in specialized medical institutions.   Introduction. Among congenital malformations of the urinary system, one of the most common is megaureter. The recently developed surgical techniques and, namely, minimally invasive ones for megaureter treatment, in some cases prevent or delay surgical intervention. However, if deterioration of the renal function is seen, especially in patients with the only functioning kidney, radical surgery has to be performed in a timely manner, before the formation of irreversible changes in the renal parenchyma leading to nephrosclerosis.   Purpose. To illustrate a successful surgical outcome in a patient with megaureter in the only functioning kidney when surgeons had to consider all anatomical features after ineffective previous surgical corrections.   Material and methods. The authors present a clinical observation and management of a 10-year-old patient with megaureter in the only kidney after previous ineffective surgical corrections when both open traditional methods and long-term endovesical stentings were performed but without taking into account the anatomical localization of the ureteral junction. The patient also developed a latent course of urinary tract infection and chronic kidney disease stage 3 by classification of the National Kidney Foundation (NKF), and the working group on improving outcomes of kidney diseases, Kidney Disease Outcomes Quality Initiative (KDOQI).   Results. Despite the existing problems – deficit in the ureter length caused by previous surgeries, impossible endovideosurgical laparoscopy because of metabolic disorders – the performed treatment was successful. The surgeons formed ureterocystoanastomosis by Cohen technique with extra-bladder mobilization of the ureter. Dynamic follow-up after surgical treatment lasted for 2 years. During the observation period, urodynamics of the upper urinary tract was restored and, one could see the elimination of leukocyturia, improvement of blood flow in the parenchyma of the only functioning kidney as well as stabilization of nitrogen metabolic parameters and glomerular filtration rate.   Conclusion. While choosing surgical management, surgeons should consider anatomical features of the ureterovesical junction. Such an approach has promoted good results in the discussed case.