Megaureter refers to a malformation of the ureter. This causes the ureter to become distended, which can damage the kidneys.
What is a megaureter?
A megaureter, also known as a megaloureter, is a malformation of the ureter, most of which is already congenital. The malformation is possible on one side or both sides of the body. The ureter is the anatomical structure through which urine is drained from the kidney. In addition, the ureter provides a connection to the urinary bladder. If a malformation causes a narrowing (stenosis) of the ureter, this leads to a backflow of urine from the bladder, which in turn is responsible for urinary tract infections or damage to the kidney.
Causes
Megaureter is caused by various disorders. It is important to differentiate between different types of megaureter such as a primary as well as a secondary megaureter. In medicine, a primary megaureter is defined as one in which the dilatation of the ureter is already congenital. A secondary megaureter, on the other hand, is caused by triggers outside the ureter. However, there are also numerous cases of megaureter in which no specific cause, such as urine reflux or a narrowing, can be identified. Doctors then speak of an idiopathic megaureter. Primary obstructive megaureter is caused by a narrowing that forms before the passage to the urinary bladder. This stenosis occurs because the development of the ureter was inadequate before birth. High urine pressure is formed above or in front of the stenosis, which results in severe dilatation of the ureter. Another subtype is primary refluxive megaureter. It is caused by urine reflux from the urinary bladder into the ureter. The causes of secondary or acquired megaureter vary. For example, various diseases of the urinary bladder can be responsible for a secondary obstructive megaureter, narrowing the orifice of the ureter into the bladder. One reason for this is urine stagnation caused by increased wall tension of the bladder. Possible causes include nerve-induced dysfunction of the urinary bladder or urethral valves. Secondary refluxive megaureter, on the other hand, is caused by urine reflux, most often due to obstructions or strictures on the underside of the urinary bladder.
Symptoms, complaints, and signs
Megaureter occurs when the urethral diameter widens to at least ten millimeters. In many cases, affected individuals do not experience any discomfort when the ureter dilates. For this reason, the problem is only discovered during routine examinations. However, some people may experience symptoms. These include abnormalities or pain during urination. Complications of megaureter are rare. Sometimes a urinary tract infection or inflammation of the kidney occurs, accompanied by fever. In the worst case, the pathogens spread further through the body and cause blood poisoning (sepsis). It is also possible for the renal cavities to become enlarged (hydronephrosis), which in the long term affects the kidney tissue. As a result, renal function is reduced or renal insufficiency develops.
Diagnosis and course of the disease
A megaureter can often be detected during prenatal diagnosis. This involves a prenatal ultrasound examination (sonography) in the fetus to reveal a disturbance in the transport of urine. Accurate and regular checks are necessary because the megaureter can lead to urinary tract infections or kidney damage. Because megaureter rarely causes symptoms, in most cases it is only noticed by routine checks. Various special procedures can take place to perform further examinations of the ureter. These include, for example, a micturition urethrography (MCU) or a micturition urethrogram. These procedures can either refute or confirm urinary reflux as a trigger. Further information about urine outflow and renal function can be obtained by nuclear medicine scintigraphy. Imaging of the ureter is also possible with excretory urography.During the growth of the unborn child in the womb, the megaureter often improves. This allows the ureter to stretch, which in turn results in the reduction of the dilation. However, in some cases, surgical intervention must be performed, and subsequently patients no longer have health problems.
Complications
In most cases, megaureter does not cause any particular discomfort or complications. In many cases, treatment for the disease is initiated late, as it is often diagnosed rather incidentally during checkups. In some cases, the disease can also have a negative effect on urination, causing stabbing or burning pain. This pain has a very negative effect on the quality of life and can also lead to psychological discomfort or depression. It is not uncommon for inflammation of the kidneys and fever to occur. Those affected appear fatigued and suffer from a reduced ability to cope with stress. Blood poisoning can also occur if the disease is not treated. In the worst case, the affected persons suffer from renal insufficiency and die from it. In this case, the affected persons are dependent on a donor kidney or dialysis in order to continue to survive. In most cases, the underlying disease can be treated relatively well, so there are no particular complications or limitations. If the disease is successfully treated, there is also no reduction in the patient’s life expectancy.
When should you see a doctor?
Because megaureter often remains asymptomatic for a long period of time, participation in screening examinations offered is recommended. In particular, children and middle-aged adults should take advantage of the offer of check-ups supported by health insurance physicians. This enables early detection and a treatment plan can be drawn up and applied before the onset of possible symptoms. If the affected person experiences peculiarities and changes while going to the toilet, a visit to the doctor should take place. If urination triggers a sensation of pain, clarification by a doctor is recommended. Taking a pain medication should be avoided until a medical professional is consulted to prevent further irregularities or complications. Fever, a general feeling of malaise or inflammation of the bladder, ureters and kidneys should be discussed with a physician. If the symptoms recur or increase in intensity, a comprehensive examination is recommended. If left untreated, germs may spread in the organism. The affected person is at risk of blood poisoning and thus a life-threatening condition. Therefore, a doctor should be consulted in case of persistent symptoms or frequent recurrence of inflammatory diseases. If there is a change in the amount of urine, the color of the urine or the odor of the excretion, a doctor is needed. There is a dysfunction of the kidney for which treatment is needed.
Treatment and therapy
Treatment of megaureter depends on its precipitating cause. If it is a secondary megaureter, the focus is on treating the causative underlying disease to achieve improvement. If a megaureter is caused by urinary reflux, conservative therapy is usually sufficient. The same applies to a narrowing of the ureter, provided there are no restrictions on kidney function. In most cases, the child’s ureteral condition can be improved during the first year of life. During this period, children are often given antibiotics to prevent urinary tract infections. If there is a pronounced narrowing of the ureter causing megaureter, surgery is usually performed. Especially in case of deterioration of kidney function, surgical intervention is necessary. In this procedure, the narrowed ureter segment located in front of the urinary bladder is removed, the ureter is modeled, and a new connection between the bladder and ureter is created.
Outlook and prognosis
The prognosis of megaureter is favorable. It is a congenital malformation of the ureter that can be modified by surgical interventions after the affected individual is born. If no other organ dysfunction is present, there is a good chance of cure.The aim of treatment is to improve the functionality of the ureter and to alleviate the existing symptoms. This can be achieved conservatively as well as through the administration of medication. This is intended to optimize the patient’s kidney function and alleviate the risk of secondary diseases. In most cases, patients achieve freedom from symptoms after the necessary corrective surgery. Often, patients can be discharged from treatment within a few months. In addition, follow-up examinations should take place so that immediate action can be taken in the event of possible changes. Nevertheless, a lifelong therapy is not necessary. On the other hand, without the use of medical treatment, life-threatening conditions may develop. Prognosis is considerably worsened in these cases. The functioning of the organism is limited and organic damage develops. As a result, the functioning of the kidney is limited and can lead to life-threatening complications. In addition, the risk of developing infections is increased. These cause further deterioration of health.
Prevention
It is not possible to prevent a congenital megaureter. To prevent secondary megaureter, it is recommended to have triggering underlying diseases treated in time.
Follow-up
Follow-up care for megaureter is similar in many respects to that for cystitis unless the underlying disease is completely cured. To rule out recurrence and/or spread of the bacteria, the patient should attend a follow-up appointment after treatment. The follow-up can take place with the treating family doctor or a urologist. As a rule, a rapid urine test is performed at regular intervals to determine whether there is blood and/or bacteria in the urine. If this is the case, the therapy may have to be prolonged. The patient himself should take it easy and protect the kidney area from traction. Activities that could additionally irritate the ureters, such as swimming, should therefore initially be avoided. Hypothermia in the feet should also be counteracted by wearing thick socks. In addition, it is important for the patient to drink plenty of fluids. This is essential for the kidneys to eliminate harmful substances and bacteria with the urine. Urinary tract infections often have to be treated with antibiotics. This usually kills not only the bacteria responsible for the UTI, but also positive-minded intestinal inhabitants that are essential for the immune system. Some patients complain of diarrhea and stomach cramps after antibiotic therapy. In this case, a colon cleanse can provide relief.
What you can do yourself
In many cases, megaureter does not need to be treated. A weakly pronounced malformation of the ureter usually does not cause any major discomfort and is accordingly harmless. However, if symptoms such as pain during urination or flank pain occur, this must be clarified by a doctor. Accompanying medical treatment, some measures can be taken to alleviate the discomfort. Cooling compresses are a proven home remedy. Quark compresses and similar remedies can also reduce pain in the abdomen and kidney area. In the case of fever, rest and bed rest are recommended. This should always be accompanied by a medical examination to detect any complications at an early stage. If kidney function deteriorates, surgical treatment is indicated. The patient must then take it easy and pay attention to increased hygiene in the area of the surgical wound to prevent wound healing disorders and similar conditions. If any unusual symptoms develop, a physician must be informed. Since a megaureter is often also a psychological burden, the patient should see a therapist to accompany the medical treatment. In the case of chronic conditions, it is even more important to learn how to deal positively with the disease and its consequences.
