The effectiveness of ureterocystoanastomosis with megaureter, depending on the method of operation, is 93-99%.
With an extremely pronounced decrease in the secretory capacity of the kidney (insufficient secretion with dynamic nephroscintigraphy more than 95%), nephroureterectomy is performed.
In case of an immediate threat to the patient’s life due to renal failure or purulent-septic complications with megaureter, a “salvage” ureterocutaneostomy (suspended, T-shaped, terminal) is performed, which allows the patient to be taken out of a serious condition. Subsequently, after eliminating the main cause of the development of the megaureter, the closure of the reterocutaneostomy is performed.
An alternative method of urine diversion from the upper urinary tract is percutaneous puncture nephrostomy, which is considered less traumatic than ureterocutaneostomy. In the future, it is not necessary to perform repeated surgery to close the ureterocutaneostomy.
Recently, various minimally invasive methods of treating a megaureter have been more and more actively introduced:
- endoscopic dissection:
- balloon dilation;
- PMS stenting in obstructive megaureter;
- endoscopic introduction of bulking agents into the orifice of the ureter with refluxing megaureter.
However, the lack of data on the long-term consequences of minimally invasive methods of treating megaureter determines the limited application of these methods. The main application of minimally invasive methods is found in debilitated patients, in the presence of pronounced concomitant diseases and with other contraindications to conventional open methods of surgical treatment of the disease.
Thus, surgical intervention for neuromuscular dysplasia of the ureter is aimed at restoring the passage of urine from the pelvis through the ureter to the bladder, at reducing the length and diameter of the ureter without disrupting the integrity of its neuromuscular apparatus and eliminating VUR.