Postnatal management of primary megaureter in infants and children

This algorithm describes the postnatal evaluation and management of primary megaureter in infants and children, which is defined as ureteral size >7 mm in diameter caused by functional or anatomical abnormality involving the ureterovesical junction. It is distinct from secondary megaureter, which is caused by abnormalities in the bladder or urethra (eg, neurogenic bladder or posterior urethral valves).

BBD: bowel and bladder dysfunction; IRSG: International Reflux Study group; SFU: Society for Fetal Urology; UTD: urinary tract dilation classification system; VCUG: voiding cystourethrography; VUR: vesicoureteral reflux.

* Postnatal ultrasonography should be performed within the first few weeks of life for infants with unilateral megaureter and within 24 to 72 hours for those with any signs of possible lower urinary tract obstruction on prenatal ultrasound, including bilateral ureteral dilation, bilateral hydronephrosis, and/or dilated bladder or thickened bladder wall.

¶ Symptoms and signs suggesting obstruction are upper tract urinary infections/pyelonephritis, episodic flank pain, calculi, or hematuria.

Δ For infants <2 months of age, our regimen for prophylaxis is amoxicillin 10 to 15 mg/kg once daily. After 2 months of age, we switch to trimethoprim-sulfamethoxazole (2 to 3 mg/kg once daily; dose for the trimethoprim component) or nitrofurantoin (1 to 2 mg/kg once daily). The regimen is generally continued through infancy and until the child is toilet trained.

◊ Indications for surgery are signs of obstruction on diuretic renography, increasing hydronephrosis, decreasing kidney function, or development of symptoms^Δ.

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Postnatal management of primary megaureter in infants and children