# Radiological Discovery of Asymptomatic Megaureter: A Rare Urological Anomaly and Literature Review

## TL;DR

An 80-year-old woman was found to have a rare, asymptomatic megaureter during imaging for kidney issues, highlighting the condition's unusual presentation in adults.

## Contribution

This paper reports a rare case of asymptomatic megaureter in an elderly adult, expanding understanding of its clinical presentation and management.

## Key findings

- The patient had bilateral dilated ureters discovered incidentally during abdominal imaging.
- No symptoms or secondary causes were found, supporting a diagnosis of primary megaureter.
- The case emphasizes the importance of identifying asymptomatic megaureters to avoid misdiagnosis.

## Abstract

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.