Megaureter, characterised by a dilated ureter without evidence of obstruction at the vesicoureteral junction, is a condition primarily associated with paediatric populations. It is often diagnosed early in life due to urinary tract infections, hydronephrosis, or other urinary symptoms. In contrast, megaureters in adults are rarely encountered, particularly in asymptomatic individuals. This discrepancy in age-related presentation raises important questions regarding the natural history, detection, and clinical relevance of the condition in older patients. This paper presents a rare case of an incidentally discovered, asymptomatic megaureter in an 80-year-old adult female who underwent abdominal imaging for new, declining renal function. Radiologic evaluation revealed bilateral markedly dilated ureters, right more than the left. The patient reported no history of urinary tract infections, flank pain, haematuria, or voiding difficulties. A comprehensive workup ruled out secondary causes, such as obstructive uropathy, neurogenic bladder, or ureteral stricture, supporting a diagnosis of megaureter. In paediatric practice, primary megaureters are well-documented. Many are identified via prenatal ultrasound or early postnatal imaging and may require surgical intervention depending on the degree of dilation and associated complications. Conversely, the literature on adult megaureters, especially asymptomatic cases, is extremely limited, with only a handful of case reports and small series available. The condition may remain clinically silent for decades, only to be discovered incidentally during imaging for unrelated conditions, as in our case. While intervention is often unnecessary in asymptomatic individuals with preserved renal function, proper identification is important to guide follow-up, prevent potential complications and distinguish benign congenital anomalies from acquired pathologies such as malignancy or obstructive uropathy. Surgical interventions, such as reimplantation of the ureter and endoscopic balloon dilatation, are reserved for some cases.

Congenital megaureter, a rare condition in adults characterized by an abnormally widened ureter, is sometimes diagnosed when individuals develop kidney stones. These stones may form within the dilated ureter itself or in the kidney or ureter above the widened segment. Although uncommon in adults, congenital megaureter should be considered in cases of isolated lower ureteral dilation, as its management may require more complex surgery to prevent recurring symptoms.

To summarize our experience in the management of congenital anomalies in the kidney and urinary tract (CAKUT) in adults. We conducted a retrospective chart review of all adult patients who underwent primary surgical intervention for CAKUT between 1998 and 2021. The study included 102 patients with a median age of 25 (interquartile range, 23-36.5). Of these, 85 (83.3%) patients reported normal prenatal ultrasound, and the remaining 17 (16.7%) patients were diagnosed with antenatal hydronephrosis. These patients were followed-up conservatively postnatally and were discharged from follow-up because of the absence of indications for surgical intervention or because they decided to leave medical care. All studied adult patients presented with the following pathologies: 67 ureteropelvic junction obstructions, 14 ectopic ureters, 9 ureteroceles, and 6 primary obstructive megaureters, and the remaining 6 patients were diagnosed with vesicoureteral reflux. Forty-three percent of the patients had poorly functioning moieties associated with ectopic ureters or ureteroceles. Notably, 67% of patients underwent pyeloplasty, 9% underwent endoscopic puncture of ureterocele, 3% underwent ureteral reimplantation, 6% underwent endoscopic correction of reflux, 7% underwent partial nephrectomy of non-functioning moiety, and the remaining 9% underwent robotic-assisted laparoscopic ureteroureterostomy. The median follow-up period after surgery was 33 months (interquartile range, 12-54). Post-operative complications occurred in 5 patients (Clavien-Dindo 1-2). Patients with CAKUT present clinical symptoms later in life. Parents of patients diagnosed during fetal screening and treated conservatively should be aware of this possibility, and children should be appropriately counseled when they enter adolescence. Similar surgical skills and operative techniques used in the pediatric population may be applied to adults.

We present a case of transient form of type 1 pseudohypoaldosteronism (S-PHA) in a 1.5-month-old male infant who presented with lethargy, failure to thrive, severe hyponatremia (Na=118 mmol/L), hypochloremia (Cl=93 mmol/L) and fever due to urinary tract infection. Potassium levels were normal. Markedly elevated serum aldosterone level and elevated serum renin confirmed the diagnosis of pseudohypoaldosteronism. Renal ultrasound showed grade III hydronephrosis on the left kidney while contrast-enhanced voiding urosonography excluded the existence of vesicoureteral reflux, which raised suspicion of obstructive uropathy at the level of vesicoureteral junction. Serum sodium normalized after several days of intravenous fluids and antibiotic therapy, after which oral supplementation of sodium was introduced. The levels of 17-hydroxyprogesterone, adrenocorticotropic hormone, cortisol and thyroid-stimulating hormone were normal. Functional magnetic resonance urography conducted at the age of 3 months confirmed the diagnosis of primary congenital obstructive megaureter and the infant was referred to a pediatric surgeon. Although a rare occurrence, S-PHA can be a potentially life-threatening condition in infants if not recognized and treated appropriately. Therefore, serum concentrations of electrolytes should be obtained in every child diagnosed with obstructive anomaly of the urinary tract and/or acute cystopyelonephritis. On the other hand, every child diagnosed with S-PHA should be evaluated for obstructive anomaly of the urinary tract.