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For the latest cutting-edge research, innovative collaborations and remarkable discoveries in child health, read stories from across all our areas of study in Q: Advances and Answers in Pediatric Health.
Urology
Megaureter
We specialize in the big things, the small things and everything in between.
What is a megaureter?
Ureters are the tubes that drain urine from the kidneys into the bladder. A megaureter is an enlarged ureter that does not function normally. While normal ureters are about 3 to 5 millimeters in diameter, a megaureter usually has a diameter of 8 millimeters or more. Megaureters can be both refluxing (meaning fluid backs up and goes in the opposite direction it should) and obstructed (blocked).
What causes a megaureter?
There are several conditions that can contribute to or cause a megaureter:
- Ectopic ureter: This is a condition where the ureter does not connect properly to the bladder and drains somewhere outside the bladder. In boys, the ectopic ureter may drain into the bladder neck or urethra near the prostate. In girls, the ectopic ureter may drain into the bladder neck, urethra, or reproductive organs. This is often associated with a duplicated kidney (duplex collecting system), where one kidney has two separate drainage systems. In this case, one ureter may drain normally into the bladder while the second does not.
- Non-obstructed megaureter: In some cases, the ureter may be enlarged but not associated with other problems. This may happen if a section of the ureter does not develop normally before a baby is born. This condition may be isolated or can be associated with other conditions involving smooth muscle defects, such as Eagle-Barrett syndrome.
- Ureterovesical junction obstruction: This is a condition where the ureter is narrowed and partially blocked where it joins the bladder.
- Ureterocele: This is a congenital condition where there is a cystic ballooning of the ureter within the bladder.
- Vesicoureteral reflux: This is a condition where the flap valve in the bladder is not long enough, causing urine to back up towards the kidney as the bladder fills.
Who gets megaureters?
Megaureters are relatively rare and usually occur during fetal development, so they are present in newborns. Many of the conditions associated with megaureter, such as vesicoureteral reflux and ectopic ureter, are more common in females.
What are the signs and symptoms of a megaureter?
- Hydronephrosis: Most cases of megaureter are discovered in routine prenatal ultrasounds by seeing an enlarged ureter and associated enlarged kidney (hydronephrosis).
- Urinary tract infection (UTI): If a megaureter causes an obstruction, the ureter may not be able to drain properly. This poor drainage increases the risk of a UTI. Megaureters due to reflux may also be associated with a UTI. Signs of a UTI include fever, back pain and blood in the urine.
- Incontinence: Girls with ectopic ureters may have continuously damp underwear if the ureter is draining below the level of the urinary sphincter. This is usually identified after toilet training.
What tests are used to diagnose a megaureter?
- Ultrasound: This procedure uses sound waves to see the kidneys and bladder to determine whether a megaureter is present.
- Voiding cystourethrogram: This study looks for reflux of urine into the ureters and kidneys. A small tube (catheter) is inserted through your child’s urethra into the bladder. We use the tube to slowly fill the bladder with a solution. While the bladder is being filled, a special machine (fluoroscopy) takes pictures. The radiologist looks to see if any of the solution is going back up into the kidneys, which confirms the diagnosis of vesicoureteral reflux. We also offer a newly developed ultrasound technique called contrast-enhanced voiding urosonography that uses a special ultrasound contrast to look for reflux without any additional radiation exposure.
- MAG III nuclear medicine imaging: This study is performed to determine kidney function and degree of blockage, if any. We use an intravenous line (IV) to inject small amounts of radioactive material to see the kidneys and determine how they are working.
- MRI/MRU: MRI is a radiation-free imaging process that uses a magnetic field and radio waves to produce detailed images of the body. MRU (magnetic resonance urography) focuses on the kidneys, ureters and bladder to give detailed information about where the ureter drains.
- Additional tests: We often use blood tests to look at overall kidney function. We also use blood pressure measurements and growth chart information to evaluate for early kidney stress.
How is a megaureter treated?
Our multidisciplinary program specializing in congenital anomalies of the kidney and urinary tract (CAKUT) closely monitors babies with megaureter to reduce the risk of UTI and ensure their kidney function is not affected.
Some children may take daily preventative antibiotics and have repeated bladder ultrasounds to monitor the condition. In many cases, the megaureter may improve on its own.
If kidney function is impaired or your child experiences recurrent UTIs, we may need to perform surgery. We use two main types of surgery to treat a megaureter:
- Cutaneous distal ureterostomy: This may be necessary in a newborn with a very enlarged ureter or poor kidney function. A surgeon moves the ureter to the surface of the skin to allow it to drain urine outside the body (where it’s caught in a diaper). This allows the affected kidney and ureter to decompress. Around 18 months of age, the ureter is then reimplanted into the bladder.
- Ureteral reimplantation: This surgical procedure involves removing the abnormal section of the ureter and reconnecting the two remaining ends. In some cases, the ureter is tailored to allow for creation of an anti-reflux valve.
Why choose us for megaureter treatment?
Our Colorado Fetal Care Center allows us to form an early diagnosis and plan for postnatal management. In conjunction with our CAKUT program, we offer a seamless transition from prenatal diagnosis to postnatal care, with the same providers being involved in both prenatal and postnatal care. Additionally, our multidisciplinary approach focuses on prevention through a comprehensive evaluation of your child’s health beyond their kidney and urologic issues, allowing us to provide care throughout infancy, childhood, and adolescence.
Helpful resources
The Urology Care Foundation supports the improvement of urological care by funding research, developing patient education, advancing humanitarian initiatives and pursuing philanthropic support.
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