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Oktar T, Selvi I, Kart M, Dönmez Mİ, Çetin B, Boyuk A, Ziylan O. Lower Urinary Tract Reconstruction for Ectopic Ureterocele: What Happens in the Long-term Follow-up? J Pediatr Surg 2023; 58:1566-1572. [PMID: 36241446 DOI: 10.1016/j.jpedsurg.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/19/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to analyze the long-term clinical and lower urinary tract function outcomes in children with duplex system ectopic ureterocele who underwent ureteroneocystostomy and ureterocelectomy. METHODS Fifty-one patients (28 females, 23 males) who underwent a series of surgical interventions including lower urinary tract reconstruction in childhood for duplex system ectopic ureterocele in our center between 1998 and 2019, were retrospectively reviewed. The demographic and clinical data, surgical history, and the indication for ureterocelectomy were noted. Lower urinary tract dysfunction (LUTD) status was assessed through dysfunctional voiding symptom scores (DVSS) and uroflowmetry in all patients at the last follow-up. The clinical outcomes, and LUTD were evaluated. RESULTS At the last visit at a mean follow-up of 117.18 ± 57.87 months after ureterocelectomy, ipsilateral persistent lower pole VUR was detected in 5.6% (3/54 renal units, 2 females and 1 male) of the cases, who were treated using the subureteric injection. Abnormal DVSS (median 11, range 9-15) was detected in 27.4% (14/51 pts) of the patients. Out of these, 57.1% (8/14 pts) had storage symptoms, 35.7% (5/14 pts) had voiding symptoms, and 7.1% (1/14 pts) had both storage and voiding symptoms while 71.4%(10/14 pts) had abnormal uroflowmetry findings (plateau shaped flow curve in 2, staccato shaped curve with sustained EMG activity in 3, tower shaped curve in 2, interrupted shaped curve in 3 patients). Five patients had elevated residual volume. Anticholinergics were administered to six patients who had overactive bladder symptoms. In addition, two girls required open bladder neck reconstruction due to stress incontinence caused by bladder neck insufficiency. CONCLUSIONS Our findings showed that clinical success was achieved using the lower urinary tract reconstruction with no need for re-operation in 90.2% of patients with duplex system ectopic ureterocele. However, LUTD was present in 27.4% of our patients in the long-term follow-up. Therefore, LUTD should be carefully assessed in the long-term follow-up of these patients.
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Affiliation(s)
- Tayfun Oktar
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey; Koç University, School of Medicine, Department of Urology, Istanbul, Turkey.
| | - Ismail Selvi
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Mücahit Kart
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - M İrfan Dönmez
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Bilal Çetin
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Abubekir Boyuk
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
| | - Orhan Ziylan
- İstanbul University, İstanbul Faculty of Medicine, Department of Urology, Division of Pediatric Urology, Istanbul, Turkey
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Ting CSY, Chang PY. An alternative lower tract approach to ectopic duplex system ureteroceles feasible in young children. J Pediatr Urol 2023; 19:87.e1-87.e6. [PMID: 36335066 DOI: 10.1016/j.jpurol.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The best surgical approach to ectopic ureters and ureteroceles is yet to be determined. The objective of this study is to provide an alternative lower tract surgical approach to ectopic ureters and duplex system ureteroceles that can be safely performed in young children. METHODS The "in-and-out" bladder approach was performed via an open intravesical incision. The upper and lower pole ureters were mobilized and brought into the bladder. The dilated ureter/ureterocele was cut open, and the distal part was deuroepithelialized. Subsequently, common sheath reimplantation was performed. The ureterocele wall was not involved during the whole procedure. We retrospectively reviewed all patients who underwent surgery for ureteroceles and ectopic ureters between January 1, 2004, and December 31, 2019. Patients with intravesical ureteroceles were excluded. Outcome parameters included the presence of hydronephrosis or reflux, split renal function on DMSA scan, incidence of urinary tract infection, and urinary incontinence. RESULTS A total of 32 patients with ectopic duplex system ureterocele who underwent the "in-and-out" bladder approach between 2004 and 2019 were included in the retrospective study. The median age at operation was 7.8 months (range: 1.5 months-3.0 years). The median length of follow-up was 6.1 years (range: 1.0 years-14.3 years). Sixteen patients (55%) had ipsilateral vesicoureteral reflux. Five patients postoperatively developed a urinary tract infection within 1-3 years. No patients required further endoscopic treatment or surgeries. During long-term follow-up, two patients (6.3%) had intermittent day wetting at the ages of 4 and 5 years and were managed conservatively. The symptoms of intermittent day wetting subsided during follow-up. CONCLUSIONS The "in-and-out bladder" approach can be performed in complex duplex system ureteroceles and enables early intervention; it is a single and simple operation with a satisfactory long-term continence rate.
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Affiliation(s)
- Cynthia Sze-Ya Ting
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, School of Medicine, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan
| | - Pei-Yeh Chang
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, School of Medicine, No.5, Fuxing St., Guishan Dist., Taoyuan City 33305, Taiwan.
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Uçan AB, Şencan A, Temir ZG, Okur Ö, Sönmez G, Öztürk M. Is lower urinary tract surgery without upper pole heminephrectomy safe and effective in the long-term treatment of duplex system ureterocele? JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221099384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The study aimed to retrospectively evaluate postoperative results of patients with duplex system ureterocele (DSU) who underwent endoscopic ureterocele incision (UI), lower urinary tract reconstruction (LUTR) or both, and investigate the necessity of upper pole heminephrectomy (UPH) in ureterocele treatment. Patients and methods: In total, 44 patients with DSU who were operated on in December 2005 and December 2018 were evaluated for patient characteristics, ureterocele location, differential renal function (DRF), vesicoureteral reflux (VUR), postoperative incontinence, proteinuria, hypertension and urinary tract infection (UTI). Results: UI was performed in 27 of 44 cases (61.3%) as the first-line treatment. Ten of them (37%) had no urinary infection or renal function loss at a mean of 3 years (1.5–7 years). LUTR was needed in 17 patients after UI due to VUR in 14 patients and bladder outlet obstruction (BOO) in 3 patients. In total, 34 patients who underwent LUTR, proteinuria or incontinence were not detected in the mean 6 years’ follow-up. Thirty-three patients (97%) had identical renal scans and similar DRF before and after the operation. No patient underwent UPH. Conclusion: UI must be considered the first-line treatment in DSU in infancy. In older patients, especially with VUR, LUTR is effective and safe and UPH mostly is not necessary. Level of evidence: 4
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Affiliation(s)
- Ayşe Başak Uçan
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Turkey
| | - Arzu Şencan
- Department of Pediatric Surgery, University of Health Sciences, İzmir Faculty of Medicine, Dr. Behçet Uz Training and Research Hospital, Turkey
| | - Zehra Günyüz Temir
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Turkey
| | - Özkan Okur
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Turkey
| | - Gökçe Sönmez
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Turkey
| | - Merve Öztürk
- Department of Pediatric Surgery, University of Health Sciences, Dr. Behçet Uz Training and Research Hospital, Turkey
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Wadham B, DeSilva A, Connolly T, Alshafei A, Keene D, Hennayake S. The place of retroperitoneoscopic hemi-nephroureterectomy for duplex kidney in children; risk of damage to the remnant moiety and strategies to reduce the risk. J Pediatr Urol 2021; 17:708.e1-708.e8. [PMID: 34454841 DOI: 10.1016/j.jpurol.2021.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/18/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To analyse the outcomes of retroperitoneoscopic upper and lower moiety hemi-nephroureterectomy (HNU) and to assess the different variables that may have an impact on outcome; remnant moiety damage, morbidity and the need for secondary surgery. METHODS Prospectively recorded data of retroperitoneoscopic HNU's performed by a single surgeon from 2005 to 2018 were analysed. Patients were split into 2 groups according to moiety affected (UMHNU and LMHNU). Clinical presentation, underlying pathology, remnant moiety DRF on renal scintigraphy, and need for further surgery were recorded. Detailed operation notes were studied regards to renal vasculature, degree of dilatation, inflammatory changes and operative difficulties encountered. Renal loss was defined as remnant moiety DRF <10% post-operatively. Change in DRF was assessed regards to the moiety, pathology and age at surgery (<1 year, 1-2 years and ≥2 years). UMHNU group was further sub-divided into 3 subgroups: ureteroceles, ectopic ureters and 'other' pathology. Statistical analysis was performed using Fishers Exact test; findings were considered statistically significant at p < 0.05. RESULTS 78 operations met the inclusion criteria on 75 patients (3 bilateral). There were no conversions to open, and 67% were performed as day-case procedures (53/78 patients). In 91.2% (71/78) patients the procedure was definitive in resolving pathology and symptoms. 7 patients needed further procedures after HNU, 5 for ureterocele/ureteric stump. Overall, there was remnant moiety renal loss in 5.1% (4/78) patients, all with UM surgery (3 ectopic ureters and 1 ureterocele). All 4 operations were recorded prospectively as 'difficult operations' due to grossly dilated UM ureter/pelvis measuring >2 cm in diameter. 2 patients had a thinned out lower moiety (LM) sitting on top of the UM renal pelvis like a pancake with all vessels stretched over this dilated pelvis/ureter causing difficulty in accurate identification. There was intra-operative concern about some damage to LM vessels in 3 patients. Age <1year was also related to increased renal loss (2/8 patients <1 year, 1/25 patients 1-2 years, 1/45 patients ≥2 years of age P = 0.005). CONCLUSION Retroperitoneoscopic LMHNU is a safe and definitive procedure with rapid recovery and minimal scarring. UMHNU has higher rates of remnant moiety loss due to more complex renal pathology, but remains a safe, successful operation on the majority of patients. Renal damage was also related to age <1year (p = 0.005) and re-operation risk after UMHNU correlated to the presence of ureterocele (p = 0.003).
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Affiliation(s)
- Bianca Wadham
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK.
| | - Amila DeSilva
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - Thomas Connolly
- Department of General Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Abdulrahman Alshafei
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - David Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
| | - Supul Hennayake
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, UK
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Hojjat A, Sabetkish S, Kajbafzadeh AM. Revascularized Pyelo-Uretero-Cystoplasty in Patients with Chronic Bladder Outlet Obstruction Due to Ectopic Ureterocele: A Safe Surgical Technique with Superior Continence Outcomes. J INVEST SURG 2021; 35:737-744. [PMID: 34139947 DOI: 10.1080/08941939.2021.1933271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. METHODS Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for 'jet/turbulent' occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. RESULTS Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24-36 months. Median bladder capacity did not rise significantly in control group. CONCLUSION Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis.
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Affiliation(s)
- Asal Hojjat
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Keene DJB, Subramaniam R. Duplex systems: Top-down or bottom-up approach? J Pediatr Urol 2020; 16:387.e1-387.e8. [PMID: 32340881 DOI: 10.1016/j.jpurol.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Duplex systems can be complicated by reflux, ureterocele, obstruction (most commonly PUJ in a lower moiety) and wetting secondary to an ectopic ureteric insertion in girls. The decision making algorithm for selection of surgical approach is complex and there is no consensus. The authors described the outcomes following an upper urinary tract approach in 2011(1) and now compare these results in a similar group of patients managed using a lower approach. OBJECTIVES To assess whether a top-down or bottom-up approach results in different likelihoods for further surgery. STUDY DESIGN A prospectively database was maintained for consecutive patients undergoing surgery for duplex systems by a single surgeon between 2003 and 2015. Patients were classified into 2 groups; Group 1 initial intention for upper urinary tract approach (heminephroureterectomy-HN) or Group 2 lower urinary tract approach (bladder reconstructive surgery-BRS). The requirement for further surgery was recorded-endoscopic incision (EI), bladder reconstructive surgery (BRS), endoscopic correction of reflux (ECR), heminephroureterectomy (HN). Indications for initial and subsequent surgery included urinary tract infection, VUJ obstruction and incontinence. Endoscopic incision was not performed for patients with an asymptomatic ureterocele. Statistical analysis consisted of Fisher's exact test with a 2 tail p value < 0.05 being statistically significant. RESULTS 79 patients underwent surgery for duplex systems. 39 patients had HN initially (Group 1) and 40 patients had BRS initially (Group 2). Further surgery was performed in 21% of patients from Group 1 (8 BRS) vs 5% of patients from Group 2 (1 redo BRS, 1 ECR). Significantly less additional surgical procedures were performed after BRS compared to HN (p = 0.048). The presence of both reflux and ureterocele increases the chances of further surgery in those patients who had HN initially compared to BRS (p = 0.01). No patients developed urinary retention or required intermittent catheterisation to improve bladder emptying. CONCLUSIONS Bladder reconstructive surgery (BRS) reduces the requirement for further surgery compared to heminephroureterectomy (HN) in symptomatic patients with a duplex kidney and either dilating vesicoureteric reflux or ureterocele.
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Affiliation(s)
- D J B Keene
- Department of Paediatric Urology, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - R Subramaniam
- Department of Paediatric Urology, Leeds General Infirmary, Leeds, LS1 3EX, UK.
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Le HK, Chiang G. Long-term Management of Ureterocele in Duplex Collecting Systems: Reconstruction Implications. Curr Urol Rep 2018; 19:14. [DOI: 10.1007/s11934-018-0758-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rabah F, Al-Nabhani D. Bilateral hydroureters and hydronephrosis in a neonate. Arch Dis Child Educ Pract Ed 2018; 103:20-21. [PMID: 27742721 DOI: 10.1136/archdischild-2016-311091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 09/21/2016] [Indexed: 11/04/2022]
Abstract
UNLABELLED : A newborn boy was diagnosed antenatally with bilateral hydronephrosis. Postnatal renal ultrasound scan (USS) measured a renal pelvic anteroposterior diameter (APD) of 12 mm on the left side and 7 mm on the right side. The baby had good urine stream. Parents missed the repeat USS at the age of 1 week. An ultrasound done at 4 weeks revealed progressive hydronephrosis, bilateral hydroureters, with increased renal echogenicity. Normal bladder wall thickness was noted but two intravesical lesions were seen (figures 1 and 2). The APD was 13.5 and 11 mm on the left and right side, respectively.edpract;103/1/20/EDPRACT2016311091F1F1EDPRACT2016311091F1Figure 1Renal ultrasound scan of (A) left kidney (LT) and (B) right kidney (RT) showing bilateral hydronephrosis (white arrows) and hydroureters (red arrow). Increased renal echogenicity is not shown in the figure.edpract;103/1/20/EDPRACT2016311091F2F2EDPRACT2016311091F2Figure 2Showing normal bladder wall thickness but two intravesical lesions were seen (white arrows). QUESTION How would you describe the intravesical lesions in figure 2? Bilateral ureterocelesBilateral vesicoureteral reflux (VUR)Bilateral pelvi-ureteric junction obstructionPosterior urethral valves (PUVs)Which complication(s) may you expect in such cases? Urinary tract infection (UTI)Obstructive voiding symptomsFailure to thriveUreteral calculusAll of the aboveHow would you treat this problem? Endoscopic punctureDeflux surgeryPyeloplastyVesicostomy Answers are on page ▪▪▪.
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Affiliation(s)
- Fatma Rabah
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Dana Al-Nabhani
- Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
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Ellerkamp V, Szavay P, Luithle T, Schäfer JF, Amon O, Fuchs J. Single-stage surgical approach in complicated paediatric ureteral duplication: surgical and functional outcome. Pediatr Surg Int 2014; 30:99-105. [PMID: 24072201 DOI: 10.1007/s00383-013-3411-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE Surgical approach to children with complicated ureteral duplication is discussed controversially. Our aim was to determine the outcome of children with complicated renal duplication undergoing a single-stage surgical approach with laparoscopic partial nephrectomy and open bladder reconstruction. METHODS Data of patients from 2004 to 2008 were investigated retrospectively. Outcome was analyzed in terms of postoperative course, renal function, urinary tract infection and functional voiding. RESULTS Thirteen patients were treated with laparoscopic partial nephrectomy and reconstruction of the lower urinary tract in a single-stage approach. Median age at operation was 15 months (2-63 m). One girl had a renal triplication. 7/13 patients presented with an ectopic ureterocele, two with an ectopic ureter, severe vesicoureteral reflux occurred in 6 patients. All patients had non-functioning renal moieties. Mean operative time was 239 min (129-309; SD 50). One re-operation was necessary 4 years after primary surgery due to a pole remnant. All patients had uneventful recoveries without evidence of recurrent UTI. Postoperative 99mTc-MAG3 scans showed no significant reduction of partial renal function (p = 0.4), and no signs of obstruction (p = 0.188). During a median follow-up of 60 months (49-86), dysfunctional voiding occurred in one patient. CONCLUSIONS In children with complicated ureteral duplication a definitive single-stage procedure is feasible and shows excellent functional results.
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Affiliation(s)
- Verena Ellerkamp
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Hoppe-Seyler-Str. 2, 72076, Tuebingen, Germany,
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Rosier PF, Szabó L, Capewell A, Gajewski JB, Sand PK, Hosker GL. Executive summary: The International Consultation on Incontinence 2008-committee on: “Dynamic Testing”; for urinary or fecal incontinence. Part 2: Urodynamic Testing in male patients with symptoms of urinary incontinence, in patients with relevant neurolo. Neurourol Urodyn 2009; 29:146-52. [DOI: 10.1002/nau.20763] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Beganović A, Klijn AJ, Dik P, De Jong TPVM. Ectopic Ureterocele: Long-Term Results of Open Surgical Therapy in 54 Patients. J Urol 2007; 178:251-4. [PMID: 17499769 DOI: 10.1016/j.juro.2007.03.063] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE We assessed the long-term results of total reconstructive bladder surgery as initial treatment of ectopic ureteroceles. MATERIALS AND METHODS Long-term followup was evaluated in 54 children treated for ectopic ureteroceles with total upper and lower urinary tract reconstructive surgery between 1988 and 2003, with special focus on the primary outcome factors continence and urinary tract infections. RESULTS Patient age at surgery was 0 to 8.8 years old (median 1.0), including 34 patients younger than 1 year. Followup was 2.3 to 15.6 years (median 9.6). Of the patients 94% became continent. During the last 2 years 17% of the patients experienced 1 or 2 uncomplicated episodes of urinary tract infection. One of the patients with incontinence received chemoprophylaxis due to frequent urinary tract infections. Secondary endoscopic procedures were necessary in 10 patients due to persistent reflux, and in 7 patients due to obstructive voiding. Reflux was present preoperatively in 33 patients, and low grade reflux was present postoperatively in 7, all of whom were treated conservatively. A total of 11 children presenting with dysfunctional voiding will be or have been trained in biofeedback. CONCLUSIONS The vast majority of patients treated with total reconstructive bladder surgery become continent and do not suffer from lower urinary tract symptoms during the long term. The reoperation rate is low compared to series beginning with endoscopic surgery. Based on the results of this study, we suggest that total reconstructive upper and lower urinary tract surgery be the treatment of choice for ectopic ureteroceles.
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Affiliation(s)
- Aida Beganović
- Department of Pediatric Urology, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
PURPOSE We examined postoperative outcome, with emphasis on bladder function, in pediatric patients who underwent bilateral ectopic ureterocele repair. MATERIAL AND METHODS We reviewed the records of 117 patients with orthotopic and ectopic ureteroceles treated between 1977 and 2000. Twelve of these patients had bilateral ectopic ureteroceles. All patients with bilateral ureteroceles were females 1 day to 2 years old at referral. Initial treatment was transureteral puncture in 6 cases, transurethral unroofing in 2 and extravesical bilateral reimplantation in 1. Of the remaining 3 patients the initial treatment was unilateral heminephroureterectomy in 1 and bilateral heminephroureterectomy in 2. Definitive treatment included bilateral upper to lower ureteroureterostomy, ureterocelectomy with trigonal and bladder neck reconstruction, and bilateral ureteroneocystotomy with or without tapering of the recipient ureter. In patients who underwent upper pole partial nephrectomy the distal upper pole ureter was removed in conjunction with trigonal surgery and ureteroneocystotomy. RESULTS There was significant morbidity in this group of patients, including voiding dysfunction and poor bladder emptying with residual urine greater than 20% of bladder capacity in 7 of 10 patients studied by serial bladder ultrasonography. Urodynamic evaluation in 3 patients revealed increased bladder compliance and large volume residual urine. Of these 3 patients 2 perform clean intermittent catheterization. Recurrent symptomatic bacteruria was noted in 7 of the 12 patients. CONCLUSIONS Patients undergoing bilateral ectopic ureterocele repair are at increased risk for postoperative voiding dysfunction. Whether this risk is present preoperatively or is a result of trigonal surgery is unclear.
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Affiliation(s)
- Neil D Sherman
- Division of Urology, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Merguerian PA, Byun E, Chang B. Lower Urinary Tract Reconstruction for Duplicated Renal Units With Ureterocele. Is Excision of the Ureterocele With Reconstruction of the Bladder Base Necessary? J Urol 2003; 170:1510-3; discussion 1513. [PMID: 14501647 DOI: 10.1097/01.ju.0000084625.17209.e4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Current practice in reconstruction of the lower urinary tract for duplicated renal systems with an associated ureterocele is excision of the ureterocele with reconstruction of the bladder and a common sheath ureteroneocystostomy. For a nonfunctioning upper pole treatment is partial nephroureterectomy. We postulate that lower urinary tract reconstruction can be performed successfully through an extravesical approach without excision of the ureterocele or reconstruction of the bladder base. We present our experience with that approach. MATERIALS AND METHODS Between 1996 and 2001, 60 patients presented with the diagnosis of ureterocele and obstruction of the upper pole ureter. Partial nephrectomy was performed in 12 cases of which 4 had reflux to the lower pole moiety. Upper pole only dismembered ureteroneocystostomy was performed in 7 of 15 cases reconstructed using the extravesical approach. RESULTS Average postoperative stay was 3.7 days. The Foley catheter was removed within 24 to 48 hours. Postoperative ultrasound showed decompression of the obstructed system and the ureterocele. Reflux was corrected in all patients. Flow rate with measurement of post-void residual 6 weeks postoperatively in toilet trained children showed complete bladder emptying. CONCLUSIONS Lower urinary tract reconstruction for duplicated renal systems with obstruction of the upper pole can be accomplished safely with decreased morbidity through the extravesical approach without excision of the ureterocele or reconstruction of the bladder base. Moreover, in instances when there is no reflux to the lower pole moiety, upper pole only extravesical ureteroneocystostomy can be performed.
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