Megaureter is an excessive elongation and dilation of the ureter, causing dysfunction of the urinary system. In most cases, the condition is congenital, but acquired forms of the pathology also occur. Treatment of megaureter (hydroureteronephrosis) in Israel aims to restore normal ureter size and eliminate complications. Given the rarity of the condition, the development and implementation of an effective therapeutic program requires a high level of qualification and experience from doctors, combined with a multidisciplinary approach. These conditions are met in Israeli clinics, ensuring normalization of the condition and a favorable prognosis in more than 90% of cases.
For the correct selection of treatment methods, it is extremely important to conduct a comprehensive examination of the patient. The latest diagnostic equipment in Israeli medical centers allows for rapid identification of the causes of dysfunction, detailed description of characteristic signs, and pathological changes in the ureter. Modern high-precision diagnostic procedures provide specialists with the necessary comprehensive information. Feedback from patients who have undergone treatment confirms the effectiveness of therapy, its acceptable cost, as well as the creation of comfortable conditions in clinics and the maintenance of a positive atmosphere essential for a speedy recovery.
Treatment Methods for the Condition
In megaureter, the excessive diameter and length of the ureter, along with its multiple kinks, cause significant difficulty in urine flow. Many patients are also diagnosed with kidney duplication or polycystic kidney disease, hydronephrosis, and some other kidney diseases. Studies show that unilateral involvement is most common, but up to 20% of cases involve bilateral megaureter. Depending on the severity of kidney dysfunction, three degrees of the condition are distinguished:
- Grade I — excretory function of the organ is reduced by less than 30%;
- Grade II — functional activity of the kidney is reduced by 30-60%;
- Grade III — organ function is suppressed by more than 60%.
Primary forms of the pathology are caused by congenital anomalies in the structure of the ureter, while secondary megaureter develops in the presence of pathologies of the urethra and bladder, such as chronic cystitis, neurogenic dysfunction, and others.
Clinical symptoms of the condition can vary. In the normal state of the bladder and urethra, megaureter usually proceeds asymptomatically and does not cause discomfort to the child. A characteristic sign of the pathology is two-phase urination, where soon after emptying, the bladder fills again with urine from the dilated ureter, leading to renewed urges to urinate. Children suffering from megaureter may lag in physical development, develop asthenic syndrome, and have reduced immunity.
Symptoms of the condition manifest at an advanced stage, after the development of chronic kidney failure or chronic pyelonephritis. The child may experience abdominal and lower back pain, hematuria, urinary incontinence, and other symptoms. Bilateral megaureter is characterized by the most severe course, where the child quickly develops chronic kidney failure and signs of acute intoxication. The presence of the pathology over a long period leads to irreversible changes in kidney structure and gradual suppression of its functional activity.
The treatment course aims to restore the shape of the ureter and normal urine flow, eliminate various complications, and address vesicoureteral reflux. Surgical intervention is indicated for this pathology, as well as minimally invasive methods. The inclusion of specific methods in the treatment plan depends on the severity of the pathological process, the degree of kidney function impairment, and the presence of kidney failure or pyelonephritis in the child.
Practice shows that in children under two years of age, manifestations of megaureter weaken or completely resolve in two-thirds of cases even without specific treatment. This is explained by the maturation and optimization of the functioning of the excretory system during this period.
Surgical Treatment
Patients in severe condition with significant kidney function impairment are indicated for surgical treatment. To alleviate painful symptoms and improve the patient's well-being, the following surgical interventions are performed:
- ureter reimplantation;
- ureterocystostomy — a surgical procedure in which the ureter is connected to the bladder;
- Boari operation — formation of an anastomosis connecting the ureter and a flap cut from the bladder wall, the ureter is wrapped with the flap, which is then sutured into a tubular shape;
- anti-reflux correction procedure;
- ureterostomy — implantation of the ureter into the skin, restoring kidney function, indicated for patients in critical condition;
- reconstructive ureteroplasty — resection of the ureter to normal diameter;
- intestinal plasty — a surgical intervention in which a segment of the ureter is replaced with a tube formed from intestinal wall tissue, this operation is complex and is not indicated for weakened patients or those in severe condition;
- nephroureterectomy — an operation aimed at removing the kidney along with the ureter, indicated for irreversible pathological changes in the kidney and significant impairment of organ function.
Minimally Invasive Methods
Indicated in cases where there are contraindications to surgical treatment, particularly for weakened patients or in the presence of comorbidities. The following minimally invasive techniques are used in the treatment of megaureter:
- transurethral resection;
- ureter dilation;
- ureteral stenting (indicated in cases of obstructive forms of the pathology);
- balloon dilation of the ureter (expansion of the narrowed ureter by introducing an inflatable balloon through the urethra and bladder).
How the Condition is Diagnosed
Megaureter is most often detected during intrauterine development through obstetric ultrasound. To confirm suspicions of the presence of pathology in a child over 3 weeks old, a comprehensive examination is required, which takes about three days in Israeli clinics.
At the initial consultation with a pediatric urologist, to whom the patient is referred immediately upon admission to the clinic, the specialist conducts a superficial examination and thoroughly questions the parents about the symptoms exhibited by the child and the nature of the pregnancy. The appointment concludes with the prescription of necessary examinations.
Performing the diagnostic procedures listed:
- ultrasound examination (US) of the kidneys;
- ultrasound Dopplerography (USDG) of the renal vessels;
- cystography;
- excretory urography;
- nephroscintigraphy;
- uroflowmetry;
- computed tomography (CT) of the kidneys;
- laboratory urine tests.
The results of the studies are reviewed by a council consisting of a urologist and specialized experts. After examining the obtained data, the doctors collectively make a diagnosis and develop a treatment program.
How Much Does Treatment Cost
The cost of therapy is one of the most relevant questions for medical tourists. Treatment in an Israeli clinic costs approximately 30% less than in Western European countries and allows for savings of up to 50% compared to expenses in the USA.
Advantages of Treatment in Israel
- High effectiveness of the treatment provided.
- Modern material and technical base.
- Surgical operations performed using the latest progressive techniques.
- Rapid accurate diagnosis.
- Affordable prices.
In the absence of timely comprehensive therapy, megaureter can lead to severe complications. Immediate referral to an Israeli clinic and prompt initiation of treatment will restore your child's health and enable them to lead an active life in the future.