[Is effective the initial management of primary nonrefluxing megaureter with double-J stent?].

BACKGROUND: Initial management of patients with primary nonrefluxing megaureter (PNRM) associated with impaired renal function or with high risk rate of decreased kidney function can be a dilemma. We present our experience in the use of double -J stent in these patients to evaluate the role as a method to decompressing the system, to prevent function loss or to temporize surgical treatment.

METHODS: In the period 1996-2006 27 patients were diagnosed of PNRM. The patients classified themselves in two groups according to the initial treatment received: those with conservative management and those managed with double-J stent insertion during 6 months. A complete reassessment was performed after one year from the diagnosis in the first group and three months after stent removal in the second one. Patients underwent uretereral reimplantation if, at assessment, an obstructed excretion pattern was found on diuretic testing. The following data have been studied in each case: age at diagnosis, sex, renal function previous and after the treatment, morbidity associated to the double- J stent insertion, excretion pattern on diuretic testing after initial management, surgical technique, ureteral tapering, outcome and time of follow-up.

RESULTS: 15 cases were managed with conservative conduct. After a 12 month period an obstructed excretion pattern was found on diuretic testing in eight patients (53.3%), and an unobstructed one in seven (46.7%). The differential function of the affected kidney got worse in two cases (15.4%), being in one of them less than 10%. Eight patients underwent a surgical intervention (53.3%), in seven cases was performed ureteral reimplantation and in one case was performed a nefrectomy. Four cases needed ureteral tapering (57.1%). Twelve patients were selected to undergo double- J stent insertion for al 6-month period. Stent-related complications developed in 5 cases (41.7%), including upper migration in two cases, distal migration in two and breakthrough infections in one patient. At reassessment three months after stent removal, 6 patients (50%) presented an obstructive pattern and the other cases an unonobstructive pattern (50%). In one of the patients with impaired function, the kidney function got worse until becoming smaller than 10%. Six patients underwent surgical treatment (50%), a nefrectomy and 5 ureteral reimplantation. None case needed ureteral tapering. Mean time of follow-up has been 7 months in the first group and 3 years and 3 months in the second one.

CONCLUSIONS: Double-J stent insertion in patients with PNRM is associated with high morbidity and there weren't differents in the final outcomes between both groups, therefore it's necessary to create severe prognosis indicators to use the double-J stent as a method to temporize a surgical treatment.