This document discusses the presentation, diagnosis, and management of megaureter. It describes the case of a 38-year-old male patient who presented with repeated left flank pain. Imaging showed left back pressure changes and a stenotic segment in the distal left ureter. The patient underwent balloon dilation of the stricture followed by left ureteric reimplantation using a split cuff-nipple technique. Post-operative cystography showed no reflux, and the patient's symptoms resolved.

1. MEGAURETERMEGAURETER
DR.MOHAMED ASHRAFDR.MOHAMED ASHRAF MOSTAFAMOSTAFA
MS.FRCSMS.FRCS

2. 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.

3. MEGAURETERMEGAURETER
Ureteral dilatation inUreteral dilatation in
absence of vesicalabsence of vesical
dysfunction ordysfunction or
urethral obstruction .urethral obstruction .
Males > females .Males > females .
Lt. > Rt.Lt. > Rt.

4. Refluxing Obstructed Non refluxing
Non obstructed
Primary Secondary Primary Secondary Primary Secondary
MEGAURETER
Congenital
refluxing
megaureter
PUV
Neurogenic
bladder
Adynamic
Segment
Intrinsic obst.
PUV
Neurogenic
Bladder
Extrinsic obst.
Idiopathic Diabetes
Insipedus
Infection
Residual
Post-obst.
dilatation

5. MEGAURETERMEGAURETER
Megaureter
v.u.reflux.
with PUV
Refluxing
megaureterwith
Adult primary megaureter

6. Adult MegaureterAdult Megaureter

7. MEGAURETERMEGAURETER
MANAGEMENTMANAGEMENT
Conservative .Conservative .
Surgical .Surgical .
Pain.Pain.
UTI .UTI .
Renal impairment.Renal impairment.

8. U.V.ReimplantationU.V.Reimplantation
TechniquesTechniques
Transvesical.Transvesical.
Extravesical.Extravesical.
Combined.Combined.
Suprahiatal or infrahiatal .Suprahiatal or infrahiatal .

9. URETEROVESICAL REIMPLANTATIONURETEROVESICAL REIMPLANTATION
TECHNIQUESTECHNIQUES
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.

10. U.V.ReimplantionU.V.Reimplantion
TechniquesTechniques
Stefanovic & coworkers in 1991 addressed theStefanovic & coworkers in 1991 addressed the
need to prevent reflux in the adult undergoingneed to prevent reflux in the adult undergoing
Ureteral reconstruction.Ureteral reconstruction.
In a retrospective review of adults havingIn a retrospective review of adults having
undergone a ureteroneocystostomy, theyundergone a ureteroneocystostomy, they
concluded there was no difference in theconcluded there was no difference in the
preservation of renal function or risk of stenosispreservation of renal function or risk of stenosis
with antireflux versus reflux procedures .with antireflux versus reflux procedures .
Whether a non refluxing anastomosis decreasesWhether a non refluxing anastomosis decreases
the risk of pyelonephritis in an adult is uncertain.the risk of pyelonephritis in an adult is uncertain.

11. CASE PRESENTATIONCASE PRESENTATION
38 Years old patients presented with38 Years old patients presented with
repeated left flank pain since longrepeated 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.

12. IVUIVU

13. Clinical CourseClinical Course
The patient underwent cystoscopy, duringThe patient underwent cystoscopy, during
which ureterocele was excluded .which ureterocele was excluded .
On table retrograde study showed aOn 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 .TheBalloon dilatation was performed .The
internal stent was removed after six weeksinternal stent was removed after six weeks

14. Balloon EndodilationBalloon Endodilation

15. POST ENDODILATIONPOST ENDODILATION
IVUIVU

16. Exposure of UreterExposure of Ureter

17. Exposure of UreterExposure of Ureter

18. Exposure of UreterExposure of Ureter

19. U.V.ReimplantationU.V.Reimplantation
split cuff-nipple techniquesplit cuff-nipple technique

20. U.V.ReimplantationU.V.Reimplantation
Split cuff-nipple implantationSplit cuff-nipple implantation

21. Post-Op. cystoscopic viewPost-Op. cystoscopic view

22. Post Op.Post Op.
Ascending CystographyAscending Cystography

23. Post Op.Post Op.
IVUIVU

24. Pre & Post - OpPre & Post - Op
Post void
Post void
15 min.
15 min.
Pre-Op
Post-OP