If tests show a block or impaired kidney function, your child may need surgery to fix it. The typical surgery for megaureters involves putting the ureters back into the bladder ("ureteral reimplantation") and trimming the widened ureter ("ureteral tapering"). If your child doesn't have a urinary tract infection or decrease in kidney function, the surgery can be delayed until he/she is 12 months old. Surgery in infants isn't easy and should be done by surgeons skilled at neonatal surgery. Many babies are kept on antibiotics until surgery to help protect them from infections.
During the procedure, the surgeon makes a cut in the lower belly. Depending on the child's anatomy, the surgeon will get to the ureter either through the bladder (transvesical) or from outside the bladder (extravesical). The ureter is removed from the bladder. If the ureter is very wide, it may need to be trimmed (tapered). Any blocks will be removed. The ureter is then replaced in the bladder. Your child may have a catheter for a few days to help healing. He/she will often stay in the hospital for between 2 and 4 days.
Most megaureters with symptoms are best treated by this open type of surgery. For obstructed megaureters, the block is removed. For refluxing megaureters, the reflux (urine back-up) is corrected. And for very wide ureters, the ureters can be trimmed.
In children over 2 years old, balloon dilation of the narrowed part may be possible. The surgeon looks into the bladder with a long, thin telescope with a light at the end (cystoscope). A small wire is passed through the bladder opening and up the ureter. A balloon is used to stretch the narrowed part of the ureter. A silicone tube is left in the ureter for 4 to 6 weeks. Studies show this can clear the block and help most cases of reflux.
Minimally invasive methods, like injecting substances to fix reflux, don't work well because of the abnormal connection to the bladder.
Laparoscopy is surgery done through thin tubes put into the body through a small cut. The surgeon uses a special camera to see inside the body and miniaturized tools. Laparoscopy for ureteral reimplantation is hard and requires a highly skilled laparoscopic surgeon.