adult megaureter
TRANSCRIPT
MEGAURETER MEGAURETER DR.MOHAMED ASHRAFDR.MOHAMED ASHRAF MOSTAFA MOSTAFA
MS.FRCSMS.FRCS
URETEROVESICAL JUNCTIONURETEROVESICAL JUNCTION
3 Features help the antireflux mechanism•Fixation of the ureter to the trigonal muscle.•Support of the detrusor posteriorly•Compressibility of the ureter.
MEGAURETERMEGAURETER
Ureteral dilatation in Ureteral dilatation in absence of vesical absence of vesical dysfunction or dysfunction or urethral obstruction .urethral obstruction .Males > females .Males > females .Lt. > Rt.Lt. > Rt.
Refluxing Obstructed Non refluxingNon obstructed
Primary Secondary Primary Secondary Primary Secondary
MEGAURETER
Congenitalrefluxingmegaureter
PUVNeurogenic bladder
AdynamicSegmentIntrinsic obst.
PUVNeurogenicBladderExtrinsic obst.
Idiopathic DiabetesInsipedusInfectionResidualPost-obst.dilatation
MEGAURETERMEGAURETER
Megaureterv.u.reflux.
with PUV
Refluxingmegaureterwith
Adult primary megaureter
Adult MegaureterAdult Megaureter
MEGAURETERMEGAURETERMANAGEMENTMANAGEMENT
Conservative .Conservative .
Surgical .Surgical . Pain.Pain. UTI .UTI . Renal impairment.Renal impairment.
U.V.ReimplantationU.V.ReimplantationTechniquesTechniques
Transvesical.Transvesical.Extravesical.Extravesical.Combined.Combined.Suprahiatal or infrahiatal .Suprahiatal or infrahiatal .
URETEROVESICAL REIMPLANTATIONURETEROVESICAL REIMPLANTATIONTECHNIQUESTECHNIQUES
Direct anastomosis.Direct anastomosis.Tunnel implantation .Tunnel implantation .Cuff nipple implantation .Cuff nipple implantation .Bladder flap procedure .Bladder flap procedure .Bladder-elongation psoas hitch procedure.Bladder-elongation psoas hitch procedure.
U.V.ReimplantionU.V.ReimplantionTechniquesTechniques
Stefanovic & coworkers in 1991 addressed the Stefanovic & coworkers in 1991 addressed the need to prevent reflux in the adult undergoing need to prevent reflux in the adult undergoing Ureteral reconstruction.Ureteral reconstruction.In a retrospective review of adults having In a retrospective review of adults having undergone a ureteroneocystostomy, they undergone a ureteroneocystostomy, they concluded there was no difference in the concluded there was no difference in the preservation of renal function or risk of stenosis preservation of renal function or risk of stenosis with antireflux versus reflux procedures .with antireflux versus reflux procedures .Whether a non refluxing anastomosis decreases Whether a non refluxing anastomosis decreases the risk of pyelonephritis in an adult is uncertain.the risk of pyelonephritis in an adult is uncertain.
CASE PRESENTATIONCASE PRESENTATION
38 Years old patients presented with 38 Years old patients presented with repeated left flank pain since long repeated left flank pain since long duration.duration.No history of bilhariziasis or T.B.No history of bilhariziasis or T.B.U/A : normal finding.U/A : normal finding.CBC, BUN , s. creatinine : normal.CBC, BUN , s. creatinine : normal.KUB : No R.O.calculi .KUB : No R.O.calculi .U/S : Lt. back pressure changes.U/S : Lt. back pressure changes.
IVUIVU
Clinical CourseClinical Course
The patient underwent cystoscopy, during The patient underwent cystoscopy, during which ureterocele was excluded .which ureterocele was excluded .On table retrograde study showed a On table retrograde study showed a stenotic segment in distal end of Lt. stenotic segment in distal end of Lt. ureter .ureter .Balloon dilatation was performed .The Balloon dilatation was performed .The internal stent was removed after six weeks internal stent was removed after six weeks
Balloon EndodilationBalloon Endodilation
POST ENDODILATIONPOST ENDODILATIONIVUIVU
Exposure of UreterExposure of Ureter
Exposure of UreterExposure of Ureter
Exposure of UreterExposure of Ureter
U.V.ReimplantationU.V.Reimplantationsplit cuff-nipple techniquesplit cuff-nipple technique
U.V.ReimplantationU.V.ReimplantationSplit cuff-nipple implantationSplit cuff-nipple implantation
Post-Op. cystoscopic viewPost-Op. cystoscopic view
Post Op.Post Op. Ascending Cystography Ascending Cystography
Post Op.Post Op.IVUIVU
Pre & Post - OpPre & Post - Op
Post void
Post void
15 min.
15 min.
Pre-Op
Post-OP