Ultrasound Comparison of Management Approaches for Primary Obstructive Megaureters in Infants: Long-Term Outcomes

This study compares two approaches for managing infants under one year of age diagnosed with unilateral primary obstructive megaureters: primary repair (PR) through upfront extravesical ureteral reimplantation and delayed staged repair (DSR), which begins with a cutaneous ureterostomy followed by reimplantation after the age of one. This retrospective analysis, spanning 2006 to 2022, included 34 infants—18 in the PR group and 16 in the DSR group. The most common symptom at presentation for both groups was urinary tract infection (UTI), occurring in over half of the cases. The PR group showed a lower postoperative complication rate (11%) compared to the DSR group (31%). In both groups, only one child required a redo reimplantation, equating to a 5.8% rate in each. After three years of follow-up, results indicated significant improvement across all participants, with reduced hydronephrosis grade, enhanced differential renal function, and no signs of obstruction. The estimated glomerular filtration rate also improved significantly in both groups (p<0.05). Success rates at three years were comparable: 94.4% for the PR group and 93.75% for the DSR group. With an average follow-up of 9.7 years for PR and 9 years for DSR, primary repair demonstrated equivalent long-term outcomes to the staged approach, showing that it is a reliable and effective management option for infants with primary obstructive megaureters. Given its lower complication rate and similar long-term outcomes, primary extravesical ureteral reimplantation may be favored for managing this condition in infants.