If you are an expecting mother, you are probably familiar with the scans that check the health of your baby. Sometimes, if the word "megaureter" appears on the scan report, it is normal to feel very scared and worried. But don't worry. If you are fully aware of this condition, you will be much stronger in facing it. Today, let's talk about what it is, why it happens, and what can be done about it.
Simply put, what is this Megaureter?
Okay, let's first understand a little about how the urinary system in our body works. We have two kidneys. These are the ones that filter our blood and make urine (pee) from unnecessary waste products. Then, there are two thin tubes that carry this urine to the bladder. These two tubes are what we call ureters .
Normally, the urethra in a healthy person is a thin tube about 9 inches long and about an inch wide. However, in a condition called ``megaureter``, this urethra is abnormally larger and wider than normal. Simply put, it is a "mega" (large) "ureter" (ureter) as the name suggests.
This is often a congenital condition that occurs while the baby is still in the womb. This is why it is often detected during prenatal imaging tests. If not treated properly, a severe condition called ``Megaureter`` can damage the baby's urinary system.
Are there main types of megaureters?
Yes, this condition can be divided into several main types depending on how it occurs. If your doctor uses these terms, let's learn about them to make them easier to understand.
| Megaureter type | What happens is simple. |
|---|---|
| Refluxing Megaureter | This is when urine from the bladder flows backward, upward, and down the ureter toward the kidney. This backward flow (vesicoureteral reflux) causes the ureter to stretch and gradually enlarge. |
| Primary Obstructed Megaureter | What happens here is that the urethra, where it connects to the bladder, becomes blocked and narrowed. It's like squeezing a water pipe at the end. This causes the urine to flow out (blockage) and the tube fills with urine, causing it to swell and become larger. |
| Primary non-obstructed, non-refluxing megaureter | In this case, neither of the above reasons are present. That is, urine does not flow backward, nor is there a blockage. But the urethra has become larger. In most cases, this condition heals on its own as the child grows. |
| Secondary Megaureters | These are caused by other medical conditions, such as a blockage in the urethra, prune belly syndrome , or a neurogenic bladder . |
What symptoms might my baby have with this condition?
Most of the time, children with megaureter do not have any symptoms . This is why prenatal scans are so important. However, some children, especially after birth, may develop symptoms. These include:
- Flank pain: Pain that comes from the side of the back, below the ribs.
- Blood in the urine (hematuria): If the urine turns pink, red, or brown.
- Frequent urinary tract infections (UTIs): Urinary tract infections can cause fever, chills, and burning when urinating.
- Fever without cause.
- Urinary incontinence: If your child is a little older, it may be difficult to control their urination.
The important thing is that not every child will have all of these characteristics. The characteristics of one child can be very different from another.
Why does this happen to babies? What is the reason?
It's hard to pinpoint a single reason for this, but there are a few main reasons that have been identified.
When a baby is growing in the womb, the urethra is made up of a layer of muscle that can contract. These muscles contract like waves to push urine from the kidneys to the bladder. We call this process ``peristalsis``.
However, sometimes, instead of this muscle, a tough, inflexible, fibrous tissue develops in a part of the urethra. This tough part cannot contract like that. As a result, the flow of urine is obstructed, and the tube fills with urine, gradually becoming larger.
In addition, a blockage at the entrance of the urethra to the bladder, or a malformation of the end of the urethra (ureterocele), can also cause a condition called ``megaureter'', which obstructs the flow of urine.
Research has found that this condition is about four times more common among boys than girls.
How do doctors diagnose this? What tests are done?
As mentioned earlier, this is often detected during pregnancy through an ultrasound scan (ultrasound/sonogram) , which allows the baby's kidneys, ureters, and bladder to be clearly seen.
If your baby shows symptoms like frequent urinary tract infections after birth, your doctor will examine your baby and recommend further tests if they suspect this condition.
- VCUG (Voiding Cystourethrogram): This is a special type of X-ray. Here, a very thin tube (catheter) is inserted into the child's urethra, and a special liquid (contrast dye) is passed through it into the bladder. Then, when the child urinates, an X-ray is taken to see if the liquid comes out with the urine or goes back up the urethra.
- Kidney ultrasound: This can help to check the size, shape, and presence of any obstructions in the child's kidneys and bladder.
- Renal Scan: In this test, a very small amount of radioactive material (radiotracer) is injected into a vein in the child. Then, a special scanner is used to monitor how the material passes through the kidneys. This can help determine exactly how well the kidneys are working and whether there are any blockages in the flow of urine.
- Blood tests (Electrolyte panel): The electrolyte levels in the blood are checked to see if the child's kidneys are working properly.
- Urinalysis: A urine sample is taken and checked for signs of a urinary tract infection.
How can this be treated? Is surgery necessary?
The treatment for this varies from child to child. It depends on the child's age, the nature of the symptoms, and their overall health.
The good news is that most children do not need major treatment or surgery . The condition usually gets better on its own as the child gets older.
Therefore, doctors initially adopt a "watch-and-wait" approach. During this time:
- Regular ultrasound scans are performed to check if the baby's kidneys are developing normally.
- Antibiotics may be continued to reduce the risk of urinary tract infections (UTIs).
However, if the condition does not improve within the child's first year, if the urethra becomes larger (dilates), if urinary tract infections persist, or if kidney function is affected, then surgery may be necessary.
There are two main types of surgery:
1. Ureterostomy: Here, the surgeon connects the child's urethra to a small opening (stoma) made in the abdomen. Then, urine flows directly out of the opening into the child's diaper instead of going into the bladder. This gives the urethra and kidneys a rest and allows them to recover. After a few months, when the urethra has returned to its normal size, another surgery is performed to reconnect it to the bladder.
2. Pyeloplasty: This surgery involves removing or repairing the blocked or narrowed part of the urethra, and reconnecting the remaining two parts of the urethra.
The success rate of these surgeries is very high. So there is no need to be afraid of it. The doctor will explain to you in detail what treatment is best for your child.
Are there times when you need to take your child to the ETU?
Yes. If your child has a condition called ``Megaureter'' and has any of the following symptoms along with a urinary tract infection (UTI), take them to the nearest hospital's Emergency Department (ETU) immediately .
- Back pain
- High fever
- Nausea and vomiting
Don't stay home at a time like this. It is very important to seek medical advice immediately.
Take-Home Message
- Megaureter is an abnormal enlargement of the tube that carries urine from a child's kidney to the bladder. This is often a congenital condition.
- Don't worry if you find out about this during a scan during pregnancy. Most children do not need surgery , and the condition will resolve on its own as the child grows.
- If your doctor recommends the "watchful waiting" approach, be sure to take your child for the check-up on the scheduled date.
- Frequent urinary tract infections are a common symptom of this condition. Therefore, take the antibiotics prescribed by your doctor as prescribed.
- If surgery is necessary, the success rate is very high, so don't be unnecessarily afraid of it.
- If the child has symptoms such as fever, back pain, and vomiting, take him to a hospital's Emergency Treatment Unit (ETU) immediately.
- Ask your doctor any questions or concerns you may have. They will provide you with all the information and support you need.
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