Der Primär Obstruktive Megaureter (POM) – Eine Domäne konservativer Therapie

Zusammenfassung

Der Begriff „Megaureter“ ist eine rein deskriptive Bezeichnung einer Reihe von Krankheitsentitäten. Entscheidend ist, ob der Megaureter primär oder sekundär auftritt oder ob er obstruktiv und/oder refluxiv ist. Häufig liegt eine primäre Obstruktion im Bereich des ureterovesikalen Übergangs vor. Die Therapie des primär obstruktiven Megaureters hat sich in den letzten 30 Jahren deutlich gewandelt. Wurde früher in der Mehrzahl der Fälle eine Ureterreimplantation durchgeführt, werden heute 85 – 90 % der Patienten konservativ behandelt. Neben der Reimplantation steht mit der Ballondilatation ein modernes, minimal-invasives Verfahren zur Verfügung, das ist ausgewählten Fällen zu einem Benefit für den Patienten führen kann. Da es aufgrund der Möglichkeit eines postoperativ auftretenden VUR gleichwohl nicht komplikationslos ist, muss betont werden, dass die Verfügbarkeit dieses neuen Verfahrens die generell strenge Indikation zur Operation des Pirimär Obstruktiven Megaureters nicht aufweichen sollte.

Abstract

The term “megaureter” is an entirely descriptive designation for a number of different entities. It is crucial to distinguish between primary and secondary forms of megaureter and between obstructive and/or refluxive forms. In the majority of cases, there is a primary obstruction in the terminal ureterovesical segment. The treatment of primary obstructive megaureter has changed fundamentally over the last 3 decades. Whereas ureteral reimplantation was the treatment of choice in the past, conservative treatment is now preferred in 85 to 90 % of patients. With the advent of endoscopic balloon dilatation, a modern, minimally-invasive treatment option has become an alternative to ureteral reimplantation in selected patients. However, due to the possibility of postoperative VUR (vesicoureteral reflux), it is necessary to emphasize that this option should not weaken the generally strict indication for surgical treatment of primary obstructive megaureter.

Schlüsselwörter

Megaureter - Primär Obstruktiver Megaureter (POM) - Ballondilatation

Keywords

megaureter - balloon dilatation - primary obstructive megaureter

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