If you're an expectant mother, you've probably been scared to see the word 'megaureter' on your scan report. Or maybe your little one has been getting frequent urinary tract infections. It's normal to feel a little nervous when you hear or see something like this. But don't worry, this is usually not a serious condition. Today, we'll talk about everything in a simple and clear way.
Simply put, what is this Megaureter?
Okay, let's first understand this. We all have two kidneys in our bodies, right? These kidneys produce urine (pee). Then, this urine is carried to the urinary bladder through two tubes. Just like water is carried from a water tank through two pipes. Those two tubes are called 'ureters'.
Normally, these tubes in a healthy person are very thin. But sometimes, especially at birth, one or both of these tubes can become wider and larger than normal. That's what we call a megaureter in medicine. 'Mega' means 'big'. So 'Megaureter' means 'enlarged urethra'.
Doctors often detect this during prenatal scans. It's good to be able to detect it early, because then you can take the necessary steps as soon as the baby is born.
What types of megaureter are there?
This condition can be divided into several main types depending on how it occurs. Although this may seem a bit complicated, it is easy to understand. Let's look at this table.
| Megaureter type | Simply put, this is what happens. |
|---|---|
| Refluxing Megaureter | Urine from the bladder flows backward, up the ureter, and toward the kidneys. This is called vesicoureteral reflux in medical terms. The pressure from this backward flow causes the tube to gradually enlarge. |
| Primary Obstructed Megaureter | The urethra is very narrow where it connects to the bladder. It's like a water pipe is clogged. This prevents urine from flowing down properly and causes the tube to fill up, causing it to swell and become larger. |
| Primary non-obstructed, non-refluxing megaureter | Here, both of the above reasons are absent. That is, urine does not flow backward, nor is there a blockage. But the duct is large. Most of the time, this type gets better on its own with time. |
| Secondary Megaureters | This can occur as a side effect of another medical condition, such as a blockage in the urethra, a birth defect such as prune belly syndrome , or damage to the nerves in the bladder (neurogenic bladder) . |
Does the baby have these symptoms?
Most of the time, children with this condition don't show any symptoms . That's why it's often only detected through scans. But some children may develop symptoms like these:
- Frequent urinary tract infections (UTIs): This is the most common symptom.
- Side pain: Pain that comes from the side of the back, below the rib cage.
- Blood in the urine (hematuria).
- Frequent fever.
- Difficulty controlling urine (urinary incontinence).
Important: Not all children have the same symptoms. Some children may not have any of these symptoms.
Why is this happening? What is the reason?
Most of the time, this happens because of a small change that occurs as the baby develops in the womb.
Think of the urethra as a tube made of muscles. Urine travels from the kidneys to the bladder because these muscles contract like a wave, pushing the urine down. But sometimes, when a baby develops, a part of this tube becomes a bit stiffer, like fibrous tissue, instead of muscle. Then the process of pushing the urine down like a wave doesn't work properly. So the urine accumulates and the tube gets bigger.
Another cause is a blockage where the tube connects to the bladder. This can be caused by conditions like ureterocele . In that case, the tube fills with urine and becomes enlarged.
In terms of who is more likely to develop it, it can affect any baby, but research has found that it is about four times more common in boys than girls .
How do doctors find this?
As mentioned above, this is often detected during prenatal ultrasound scans during your pregnancy.
After the baby is born, the doctor will examine the baby. Then, to further confirm the condition, the following tests may be performed:
- Voiding Cystourethrogram (VCUG): This is a type of X-ray. A small tube is inserted into the baby's urethra and a special dye is injected into it. The X-ray then looks to see if the fluid is in the bladder or if it is refluxing back up the tube.
- Kidney ultrasound: This scan is done to see how the baby's kidneys and bladder are and how large the ducts have become.
- Renal Scan: Here, a very small amount of radioactive material is injected into a vein in the baby. Then, a special scanner is used to watch how this material passes through the kidneys. This can accurately determine how well the kidneys are functioning and whether there is any blockage.
- Blood tests (Electrolyte panel): This blood test helps to see if the kidneys are functioning normally.
- Urinalysis: A urine sample is taken and tested for infection.
How is it treated? Is surgery necessary?
The question that comes to everyone's mind when they hear this is, "Oh, will my baby have to have an operation now?"
The good news is that most children do not need any surgery.
Most children get better on their own as they get older, so your doctor may take a "watch-and-wait" approach. This means:
- Regular scans: The baby is scanned at regular intervals to monitor whether the kidneys are developing properly and whether the size of the ducts is decreasing.
- Administering Antibiotics: To reduce the risk of urinary tract infections, your doctor may prescribe a low-dose antibiotic to be taken daily.
When is surgery necessary?
However, if the condition does not improve within the baby's first year, if the duct dilates, if there are persistent urinary tract infections with fever, or if kidney function is affected, the doctor may suggest surgery.
There are two main types of surgery:
1. Ureterostomy: Here, the surgeon temporarily connects the enlarged urethra to a small opening (stoma) made in the baby's abdomen. Then, urine collects directly in the diaper instead of going into the bladder. This gives the kidney and urethra a rest and allows them to recover. After a few months, this tube is reconnected to the bladder in another surgery.
2. Pyeloplasty: In this surgery, the blocked or narrowed part of the urethra is removed and the tube is reconnected properly.
The success rate of these surgeries is very high. So don't be afraid of it. Your doctor will explain to you the most appropriate treatment for your baby.
When does the baby need to go to the hospital?
If your baby has megaureter, you should be very careful about the symptoms of a urinary tract infection. If your baby has any of the following symptoms along with a urinary tract infection , take him to the nearest hospital's emergency department (ETU) immediately :
- High fever
- Back or neck pain
- Vomiting and nausea
These symptoms indicate that the infection may have affected the kidneys. So don't delay.
Take-Home Message
- Megaureter is a condition in which one or both of a baby's ureters are larger than normal at birth. This is often detected during scans during pregnancy.
- Don't be alarmed when you hear this. Most children don't need surgery . This condition will get better on its own over time.
- The most important thing is to take your baby for checkups and clinics on time, as the doctor says. Don't miss them.
- If your baby has a fever and signs of a urinary tract infection (frequent urination, crying while urinating, foul-smelling urine), see a doctor immediately.
- It is your right to openly discuss any questions or fears you have with your doctor.
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