Is There a Consensus on the Management of Primary Obstructive Megaureter?

Abstract

Objective: To analyze the results of a survey regarding the opinion of experts in diagnosis and management of primary obstructive megaureter (POM) and to determine if their current therapeutic strategy matches with the British Association of Pediatric Urologist recommendations, published in 2014.

Methods: From February 1 to June 30, 2023, an online-based survey was distributed through the eUROGEN network and some pediatric urology societies. The questionnaire was carried out using google forms and consisted of 14 questions. Additionally, a literature review of the most recent articles was performed.

Results: One hundred three medical professionals completed the survey, 98 (96.1%) were pediatric urologists. 67.3% of respondents agreed with starting continuous antibiotic prophylaxis in all patients with POM. The diagnosis of obstruction is mostly made based on a combination of findings which include initial DRF <40%, drop of DRF of >5% on serial scans and worsening of dilation at follow-up ultrasound (63.7%). When specifically asked if initial DRF <40% as a solely finding without symptoms or massive dilatation was considered as an indication for early surgery, only 12 (11.9%) considered it so. Regarding ureteral reimplantation under the age of 1, 46 (45.1%) were confident in this procedure. Among temporizing interventions, high-pressure endoscopic balloon dilatation was the most popular.

Conclusion: Current trends in the diagnosis and management of POM may challenge some of the British Association of Pediatric Urologist recommendations, especially in regards initial DRF <40% as a solely indication of surgery and the most popular temporizing procedures. It may be time to elaborate a new updated consensus and decide a common updated approach for all patients with POM.