Clinico-Pathological study of Primary Obstructive Megaureter.

Saravanan, C (2009) Clinico-Pathological study of Primary Obstructive Megaureter. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION : Megaureter (MGU) is a nonspecific term implying a spectrum of anomalies associated with pathologically excessive ureteral diameter. It implies no particular unifying pathophysiologic principles but merely groups together a spectrum of anomalies associated with increased ureteral diameter. Because surgical solutions to the anomaly are reliable, the challenge arises in differentiating nonobstructive from obstructive variants and thus better defining the indications for surgery. This is analogous to the highly debated management of hydronephrosis caused by UPJ obstruction (Koff and Campbell, 1992), with which MGU may share similar pathophysiologic principles. It is apparent by now that all dilatations of the urinary tract do not necessarily translate into physiologically significant obstructive processes with renal functional implications despite the anatomic distortion of the collecting system that they represent. Our knowledge of the megaureter has changed greatly over the past 15 years, primarily due to fetal sonography, which has allowed us to follow the natural history of the megaureter and gain a better insight into treatment. Many cases of antenatally diagnosed MGU will resolve spontaneously. AIM : To determine the demographic profile of primary obstructive megaureter. To analyze the clinical profile and various investigation modalities used in diagnosing primary obstructive megaureter. To analyze the methodologies used in the treatment of primary obstructive megaureter and the response to treatment during the available follow up period. METHODS : It is a combined prospective and retrospective study which included patients with primary obstructive megaureter, who attended the pediatric surgery and pediatric urology OPD at the Institute of Child Health and Hospital for Children, Madras Medical College, Chennai. The study was done during the five years period, from Jan 1, 2004 to Dec 31, 2008. CONCLUSION : The patients with primary obstructive megaureter are noted predominantly in infants (36.85%) with maximal incidence between 1 to 3 months (6 out of 14 infants). In this study, the sex distribution is found as male : female – 5.3 : 1, with definitive male Preponderance. The laterality distribution is noted as U/L : B/L - 4.4 : 1, with slight predominance of right side over left side as 1.2 : 1. In this study, the most common symptom at presentation is febrile UTI (63.15%), followed by asymptomatic patients (26.32%). The contra-lateral renal dysplasia in U/L cases is found to be 3.26%. The majority of cases with retro-vesical ureteric size lie between 1 to 1.5 cm (48.8%), which are not considered to belong to the spontaneously resolving group. In this study, all patients primary obstructive megaureter are noted to have normal renal biochemical parameters, irrespective of bilateral presentation. MCU and IVU are the most common investigational modality performed. In this study, patients presented during infancy were initially observed prior to surgical intervention. But those patients presented beyond infancy were evaluated and intervened surgically during the same admission. Cohen’s Uretero-neocystostomy with intra-vesical approach is the surgical procedure of choice, in majority of the case, in this study. The histo-pathological evaluation revealed co-existence of circular muscle hyperplasia, longitudinal muscle hypoplasia, and collagen infiltration in majority of cases followed by features of inflammation and mucosal ulceration. The re-implantation failure was noted in 28.12% ( includes persistent obstruction and minimal grades of VUR).

Item Type: Thesis (Masters)
Uncontrolled Keywords: Primary Obstructive Megaureter ; Clinico-Pathological Study.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 03:00
Last Modified: 28 Jul 2017 03:00
URI: http://repository-tnmgrmu.ac.in/id/eprint/2290

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