שאלה משלב א׳ בכירורגיה אורולוגית · מועד 2024 (Sep), שאלה 49

Correct: D — a distal cutaneous ureterostomy. A three-month-old with primary obstructive megaureter and recurrent febrile infections needs decompression and infection control, but the infant ureter and bladder are too small for a durable reimplantation at this age, and the operation has a high complication rate before about 12 months. Temporary cutaneous diversion — a distal ureterostomy or refluxing reimplantation — relieves the obstruction and allows definitive reconstruction later. Reimplantation now (option C) is the operation to be deferred, close observation (option B) is unacceptable with febrile infections, and nephrostomy (option A) drains the kidney but leaves the obstructed megaureter as the reservoir of infection.

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