Pediatric Megaureter

Megaureter is a ureter that is much wider than normal. The ureters are the tubes that carry urine from the kidneys to the bladder. A ureter that is wider than 3/8 inch is a megaureter. A megaureter may not drain urine normally. Urine may back up into the kidneys. This can lead to infections and kidney damage.

A megaureter occurs when a baby is growing in the uterus. A normal ureter has a layer of muscle tissue. This muscle layer helps send urine down the tube with movement called peristalsis. But part of this layer may be replaced with stiff, fibrous tissue instead. This prevents normal peristalsis. A megaureter may also occur if there is a blockage stopping urine from entering the bladder. This causes a backflow of urine toward the kidney, widening the ureter.

A megaureter can occur on its own without other existing conditions. But it often occurs along with other problems, such as prune belly syndrome.

Symptoms can be a bit different for each child. They can include:

• Not passing much urine
• Blood in the urine
• Signs of infection, such as pain when urinating

The symptoms of megaureter can seem like other health conditions. Take your child to their healthcare provider for a diagnosis.

Often a megaureter is diagnosed by ultrasound while a woman is still pregnant. After birth, some babies have other problems that mean they may have a megaureter. Children who are diagnosed later often have urinary tract infections (UTIs). The healthcare provider will ask about your child’s symptoms and health history. They will give your child a physical exam. Your child may also have tests, such as:

• Intravenous pyelogram (IVP). This is an imaging test that uses an X-ray to look at the urinary tract. A contrast dye is given so that the tract can be seen on film. An IVP also shows the rate and path of urine flow through the urinary tract.
• CT scan. This is an imaging test that uses a series of X-rays. A computer then puts the X-rays together to form detailed pictures of the abdomen and kidneys.
• Voiding cystourethrogram (VCUG). This is a type of X-ray of the urinary tract. A thin, flexible tube (catheter) is put in the tube that drains urine from the bladder to the outside of the body (urethra). The bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.
• Abdominal ultrasound. This imaging test looks at internal organs as they function and at blood flow through blood vessels.
• Diuretic renal scan. This is a nuclear imaging test. It’s done by injecting a radioactive fluid into a vein. The radioactive material is then carried to the kidneys, where it gives off signals that can be captured with a special camera. During the scan, a diuretic medicine is given to speed up urine flow through the kidneys. This helps show any blocked part of the urinary tract.
• Blood and urine tests. These are done to check for UTI, check your child's electrolytes, and to see how your child's kidneys are working.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Your child may need to take antibiotics to prevent urinary tract infections. In some cases, the megaureter will go back to normal on its own over time. If there is a blockage of the urinary tract, your child may need surgery. The surgery removes the part of the ureter that is abnormal.

Talk with your child’s healthcare providers about the risks, benefits and possible side effects of all treatments.

Possible complications of megaureter include:

• Reverse flow of urine into the kidneys
• Pooling of urine inside the ureter that doesn’t drain
• Urinary tract infections
• Kidney damage
• Kidney failure

Call the healthcare provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms