What is Primary Obstructive Mega Ureter (POMU)?

POMU is a congenital condition where the ureter (tube connecting kidney to bladder) is abnormally dilated and has impaired drainage because of a narrowing or functional obstruction at the lower ureteric segment. It may present in infants or be detected antenatally on ultrasound.

How is POMU usually diagnosed?

Diagnosis begins with renal ultrasound showing ureteral dilation. Further tests like micturating cystourethrogram (MCU) exclude co-existing reflux. Diuretic renography (DTPA or MAG3) is used to assess drainage and split renal function to determine whether an obstruction is significant and whether surgery is needed.

When is conservative management appropriate?

Many infants with POMU who have good drainage on renogram and preserved renal function can be safely observed with periodic ultrasound and clinical follow-up. Conservative care focuses on infection prevention, growth monitoring and repeat imaging to detect deterioration early.

What are the treatment options for POMU?

Treatment ranges from observation to minimally invasive endoscopic approaches (temporary stenting or balloon dilatation in select cases) and definitive reconstructive surgery — commonly ureteric tapering with ureteric reimplantation into the bladder. Choice depends on drainage, renal function, infection history and symptoms.

When is surgery recommended for POMU?

Surgery is recommended when there is poor drainage on diuretic renogram, decreasing split renal function, recurrent urinary infections, progressive hydronephrosis on ultrasound, or symptoms such as pain or urinary obstruction.

What does ureteric tapering and reimplantation involve?

Ureteric tapering reduces the diameter of the dilated distal ureter to restore peristalsis and prevent kinking, followed by reimplantation into the bladder (ureteroneocystostomy) to create a competent valve mechanism. This can be performed via open or minimally invasive (laparoscopic) techniques depending on the child and surgeon preference.

How is kidney function monitored in children with POMU?

Kidney function is monitored with serial ultrasound, renal function blood tests and periodic diuretic renography (DTPA/MAG3). If there are concerns about scarring, DMSA scan is performed. Early detection of worsening function prompts timely intervention.

Can POMU lead to urinary tract infections (UTIs)?

Yes — poor drainage can predispose to urinary stasis and recurrent UTIs. Preventing and promptly treating infections is a key part of management while decisions about definitive surgery are being made.

What is the recovery like after ureteric surgery?

Hospital stay is typically short for uncomplicated cases. Children usually have a urinary catheter and sometimes a stent for a few weeks; pain is managed effectively and most resume normal activities within days to weeks. Follow-up imaging confirms good drainage and healing.

Primary Obstructive Mega Ureter (POMU) Treatment in Gomti Nagar Extension, Lucknow

POMU (Primary Obstructive Mega Ureter) Care — Assessment and Treatment Options

Primary obstructive mega ureter (POMU) is a congenital condition where an affected ureter is enlarged and shows delayed or obstructed drainage at its lower end. Early and accurate assessment is important to protect renal function and prevent recurrent infections. At Swastik Urology Clinic, under the expertise of Dr. Aditya Sengar (Urologist), we provide careful imaging-based diagnosis, conservative monitoring where safe, minimally invasive interventions when appropriate, and definitive reconstructive surgery when needed — all tailored to the child's or adult patient's needs.

How POMU commonly presents

Many cases are detected on antenatal ultrasound as a dilated ureter or hydronephrosis. Postnatal presentation ranges from asymptomatic dilation to urinary tract infections, abdominal or flank pain, palpable abdominal mass, or impaired growth in children. Sometimes an adult may present with flank pain or recurrent infections.

Essential investigations

Typical workup includes:
• Renal and bladder ultrasound to document dilation and kidney size.
• MCU/VCUG to rule out vesicoureteric reflux.
• Diuretic renogram (DTPA/MAG3) to assess drainage and split renal function.
• Urine culture and routine blood tests to evaluate infection and renal function.

When is observation reasonable?

Infants with good drainage on renogram, stable or improving ultrasound measurements, preserved split renal function and no recurrent infections may be managed with close observation and regular imaging. Many mild cases show improvement over time.

Endoscopic and minimally invasive options

In selected patients, temporary ureteric stenting or endoscopic balloon dilatation of the distal ureter may improve drainage and serve as a bridge to definitive treatment. These are case-specific decisions made after careful imaging and discussion with parents or patients.

Definitive reconstructive surgery

When obstruction, declining renal function, recurrent infections, or persistent symptomatic dilation are present, reconstructive surgery is advised. Procedures commonly include ureteric tapering (to reduce diameter and restore peristalsis) followed by ureteric reimplantation (ureteroneocystostomy). Laparoscopic approaches are used when suitable to reduce pain and hasten recovery.

Decision-making: what we consider at Swastik Urology Clinic

We individualise care considering:

• Degree of ureteral dilation and kidney size on ultrasound.
• Renogram drainage pattern and split renal function.
• Presence of urinary infections and response to antibiotics.
• Age, symptoms and parental preferences.
• Associated urinary tract anomalies.

Our aim is to preserve kidney function while avoiding unnecessary surgery.

Procedure & recovery — what to expect

For endoscopic interventions, hospital stay is short and recovery rapid. For reconstructive ureteric surgery, children usually stay in hospital for a few days; catheters or stents may be placed temporarily. Pain is controlled with standard medications and follow-up imaging ensures successful drainage and healing.

Long-term outlook & follow-up

With timely intervention when indicated, most children achieve good drainage and preserved kidney function. Long-term follow-up includes periodic ultrasound, urine testing and renography when indicated; management aims at preventing infections, monitoring growth and ensuring normal renal development.

Is antenatal hydronephrosis the same as POMU?

Antenatal hydronephrosis is a broad finding on ultrasound which may be due to several causes, one of which is POMU. Postnatal evaluation with ultrasound and renography is needed to identify the cause and plan follow-up or treatment.

Will my child's dilated ureter always need surgery?

Not always. If drainage is good on renogram and kidney function is preserved, observation with regular imaging is often chosen. Surgery is recommended only if drainage worsens, function declines, or infections recur.

Can POMU cause kidney damage?

Prolonged obstruction and poor drainage can impair kidney growth and function. Timely monitoring and appropriate intervention when indicated help protect the kidney.

Are there non-surgical options to improve drainage?

In selected cases temporary stenting or endoscopic balloon dilatation may improve drainage and avoid or delay definitive surgery. These options are considered based on individual imaging and clinical factors.

What follow-up tests are required after treatment?

Follow-up commonly includes ultrasound to document ureter and kidney size, urine cultures to check for infection, and periodic diuretic renography (DTPA/MAG3) to confirm good drainage and stable or improved split renal function.

How do I book an evaluation for POMU?

Call or WhatsApp Swastik Urology Clinic at +91 6387212291 to schedule a consultation with Dr. Aditya Sengar. Bring any antenatal/postnatal ultrasound reports and urine culture results for the first visit.

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Primary Obstructive Mega Ureter (POMU) Treatment in Gomti Nagar Extension, Lucknow

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