Clinicopathological study of primary obstructive megaureter

C. Saravanan, Karpaga Vinayagam


Background: Megaureter is a non-specific 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. To analyse the clinical profile and various investigation modalities used in diagnosing primary obstructive megaureter.

Methods: This prospective study was conducted in March 2017 to August 2019 at the Institute of Child Health and Hospital for Children (ICH and HC), Egmore, Chennai.

Results: The most common presentation was febrile urinary tract infection, second most presentation was asymptomatic patients, on post-natal evaluation of antenatally diagnosed cases. The most common finding on the antenatal scan is uretero-hydronephrosis. Maximum incidence of ureteric size - between 1 and 1.5 cms. 13 patients underwent surgery after an initial period of observation from the time of presentation. These patients belong to the period of infancy. The coincidence of circular muscle hyperplasia and longitudinal muscle hypoplasia was noted in 18 patients.

Conclusions: 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 through intra-vesical approach is the surgical procedure of choice, in the majority of the cases, in this study.


Congenital anomalies, Dilated ureter, Primary obstructive megaureter

Full Text:



Ruano-Gil D, Coca-Payeras A, Tejedo-Mateu A. Obstruction and normal recanalization of the ureter in the human embryo. Its relation to congenital ureteric obstruction. Eur Urol. 1975;1:287-93.

Alcaraz A, Vinaixa F, Tejedo-Mateu A, Fores MM, Gotzens V, Mestres CA, et al. Obstruction and recanalization of the ureter during embryonic development. J Urol. 1991;145(2):410-6.

Yerkes E, Nishimura H, Miyazaki Y, Tsuchida S, Brock III JW, Ichikawa I. Role of angiotensin in the congenital anomalies of the kidney and urinary tract in the mouse and the human. Kid Inter. 1998 Sep 1;54:75-7.

Chwalle R. The process of formation of cystic dilatation of the vesical end of the ureter and of diverticula at the ureteral ostium. Urol Cutan Rev. 1927;31:499-504.

Baker LA, Gomez RA. Embryonic development of the ureter and bladder: acquisition of smooth muscle. J Urol. 1998;160(2):545-50.

Escala JM, Keating MA, Boyd G, Pierce A, Hutton JL, Lister J. Development of elastic fibres in the upper urinary tract. J Urol. 1989;141(4):969-73.

Hutch JA. The mesodermal component: its embryology, anatomy, physiology and role in prevention of vesicoureteral reflux. J Urol. 1972;108(3):406-10.

Tanagho EA, Meyers FH, Smith DR. The trigone: anatomical and physiological considerations. 1. In relation to the ureterovesical junction. J Urol. 1968;100(5):623-32.

Kakuchi J, Ichiki T, Kiyama S, Hogan BL, Fogo A, Inagami T, et al. Developmental expression of renal angiotensin II receptor genes in the mouse. Kid Intern. 1995;47(1):140-7.

Nishimura H, Yerkes E, Hohenfellner K, Miyazaki Y, Ma J, Hunley TE, et al. Role of the angiotensin type 2 receptor gene in congenital anomalies of the kidney and urinary tract, CAKUT, of mice and men. Mole Cell. 1999;3(1):1-10.

Hohenfellner K, Hunley TE, Schloemer C, Brenner W, Yerkes E, Zepp F, et al. Angiotensin type 2 receptor is important in the normal development of the ureter. Pediatr Nephrol. 1999;13(3):187-91.

Sanyanusin P, Schimmenti LA, McNoe LA, Ward TA, Pierpont ME, Sullivan MJ, et al. Mutation of the PAX2 gene in a family with optic nerve colobomas, renal anomalies and vesicoureteral reflux. Nature Gene. 1995;9(4):358-64.