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Salehi-Pourmehr H, Lotfi B, Mohammad-Rahimi M, Tahmasbi F. Surgical patterns in the endoscopic management of pediatric ureterocele: A systematic review and meta-analysis. J Pediatr Urol 2024:S1477-5131(24)00195-5. [PMID: 38705762 DOI: 10.1016/j.jpurol.2024.04.005] [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: 09/13/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To assess the results of endoscopic ureterocele treatments as well as the effects of ureterocele location (intravesical vs. ectopic) and anatomy (single vs. duplicated system) on treatment outcomes. MATERIAL AND METHODS Following the Systematic Reviews and Meta-Analyses (PRISMA) standards, several medical databases as well as Google Scholar were searched comprehensively. Studies describing secondary operation outcomes for endoscopic transurethral incision and puncture were included. Studies were required to compare patients according to ureterocele location (intravesical or ectopic) and anatomy (single or duplex system) or preoperative reflux. Meta-analysis was conducted using Comprehensive Meta-analysis (CMA) software. RESULTS A total of 83 studies entered this systematic review consisting of 3022 patients. According to the meta-analysis of 16 studies, the risk ratio (RR) of reoperation after ureterocele incision was significantly higher in patients with ectopic vs. intravesical ureteroceles (RR: 2.42; 95% CI: 1.89-3.11; P < 0.001; I2: 14.89%). Also, a higher reoperation rate was reported in patients with duplex system ureteroceles (DSU) vs. single system ureteroceles (SSU) with little heterogeneity based on 9 studies. (RR: 2.50; 95% CI: 1.60-3.91; P < 0.001; I2: 13.83%). CONCLUSION Our results showed that ectopic ureteroceles and duplex systems are associated with higher reoperation rates after endoscopic procedures.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Behzad Lotfi
- Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | - Fateme Tahmasbi
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Corona LE, Lai A, Meyer T, Rosoklija I, Berkowitz R, Liu D, Maizels M, Cheng EY, Lindgren BW, Chu DI, Johnson EK, Gong EM. Retrograde incision from orifice (RIO) technique for endoscopic incision of ureterocele: 15 years of outcomes. J Pediatr Urol 2023; 19:85.e1-85.e8. [PMID: 37590379 DOI: 10.1016/j.jpurol.2022.09.024] [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: 06/30/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Management of obstructing ureterocele often includes endoscopic transurethral incision (TUI) that can be challenging secondary to uncertainty in anatomic landmarks with risk of serious complications. To this end, we innovated a technique using predictable landmarks that begins endoscopic incision at the ureterocele orifice and extends retrograde proximal to the bladder neck (Figure). OBJECTIVE With over 15 years of experience in performing this retrograde incision from orifice (RIO) technique, we aimed to examine post-operative outcomes and risk of surgical failure after RIO compared to traditional TUI techniques for ureteroceles. We hypothesized that clinical outcomes after RIO would be superior to traditional endoscopic approaches to decompression of obstructing ureterocele in infants. STUDY DESIGN A retrospective study of patients ≤12 months old who underwent TUI ureterocele at our institution between 2007 and -2021 was conducted. Pre-, intra- and post-operative characteristics were compared between patients who underwent RIO vs non-RIO TUI. Primary outcome was post-incision febrile urinary tract infection (fUTI). Secondary outcome was a composite failure measure of fUTI, secondary surgery, de novo bladder outlet obstruction, or vesicoureteral reflux. Multivariable Cox proportional hazard models were fitted to compare the time-to-event risk of primary and secondary outcomes between groups. RESULTS Ninety patients with 92 ureteroceles were included (49 RIO, 43 non-RIO). Median follow-up from TUI was 33 months. RIO had a shorter median operative duration (27 vs 35 min, p = 0.021). Primary and secondary outcomes were similar between groups (fUTI: 29% RIO vs 19% non-RIO, p = 0.27; composite failure 54% RIO vs 69% non-RIO, p = 0.15). In multivariable Cox proportional hazard models, there was no significant difference in risk of fUTI (RIO aHR 0.98, 95% CI 0.38-2.54, p = 0.97) or composite failure (RIO aHR 0.80, 95% CI 0.45-1.44, p = 0.46) between TUI techniques. DISCUSSION RIO technique for TUI ureterocele is attractive in that it uses predictable anatomic landmarks making it simple to perform. In analyzing this 15-year institutional experience of TUI ureterocele, RIO showed similar success to non-RIO endoscopic incisions. This study is a retrospective, non-randomized, single-institutional study over 15 years and is therefore subject to change in surgeon practice over time and variable practices between providers. CONCLUSIONS Given comparable success and durability over time to other TUI ureterocele techniques, and with the advantage of operator ease using consistent anatomic landmarks, RIO is a worthy option for endoscopic ureterocele decompression.
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Affiliation(s)
- Lauren E Corona
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - Andrew Lai
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, University of Illinois at Chicago, Chicago, IL, 60612 USA.
| | - Theresa Meyer
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA.
| | - Ilina Rosoklija
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA.
| | - Rachel Berkowitz
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA.
| | - Dennis Liu
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - Max Maizels
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - Earl Y Cheng
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - Bruce W Lindgren
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - David I Chu
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - Emilie K Johnson
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
| | - Edward M Gong
- Division of Urology, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611 USA; Department of Urology, Northwestern Feinberg School of Medicine, 420 E. Superior St. Chicago, Illinois, 60611 USA.
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The fate of lower pole hydronephrosis after transurethral incision of upper pole ureteroceles in children with duplex systems. J Pediatr Urol 2020; 16:847.e1-847.e7. [PMID: 33342512 DOI: 10.1016/j.jpurol.2020.09.025] [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: 02/27/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Duplex system is the most common upper urinary tract anomaly in childhood. The purpose of our study was to investigate the incidence, characteristics, and progression of lower pole hydronephrosis in children with duplex system who underwent transurethral incision (TUI) of upper pole ureterocele. MATERIALS AND METHODS Among children who underwent transurethral incision of ureteroceles between 2006 and 2018, 69 renal units with duplex systems were included after exclusion of preoperative lower pole vesicoureteral reflux and follow up loss. We retrospectively analyzed the postoperative progression of lower pole hydronephrosis and compared patient characteristics between two groups according to the presence of lower pole hydronephrosis. RESULTS The median age at operation and follow-up duration were 3.0 months (range 0-242 months) and 59 months, respectively. The median size of ureteroceles preoperatively was 14.5 mm. Thirty-five renal units (50.7%) demonstrated preoperative lower pole hydronephrosis of any grade (grade I in 13 [37.1%], II in 6 [17.1%], III in 10 [28.7%], and IV in 6 [17.1%]). In majority of cases, lower pole hydronephrosis drastically improved after transurethral incision, and 28 renal units (80%) demonstrated improvement of lower pole hydronephrosis to grade 0 or I. The preoperative diameter of upper pole ureter was significantly increased with lower pole hydronephrosis than without (11.30 ± 4.19 vs. 7.02 ± 4.94 mm, p < 0.01). Postoperative vesicoureteral reflux on upper pole was found in 16 (23%), five (7%) in lower pole. Eleven patients developed complications after TUI which required secondary surgeries. The differential renal function of affected renal units was decreased after TUI in group with preoperative lower pole hydronephrosis (46.77 ± 8.21 to 44.24 ± 8.55, p = 0.003), while it was maintained without significant difference in group without lower pole hydronephrosis (47.90 ± 6.39 to 46.24 ± 8.90, p = 0.091). CONCLUSIONS Lower pole hydronephrosis was found in a considerable number of renal units (50.7%), and the occurrence was related with the diameter of upper pole ureter. Most of renal units demonstrated significant improvement of lower pole hydronephrosis after transurethral incision of ureterocele. Given that differential renal function may be decreased even after improvement of hydronephrosis with TUI, a more careful monitoring on renal function is required in patients with hydronephrosis on lower pole.
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Torino G, Brandigi E, Roberti A, Turrà F, Palazzo G, Di Iorio G. Posterior Urethral Polyp Treated With Endoscopic Transurethral Resection: The Second Pediatric Case Managed With Holmium Laser. Urology 2020; 143:238-240. [DOI: 10.1016/j.urology.2020.04.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/28/2022]
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Comparison of electrocautery versus holmium laser energy source for transurethral ureterocele incision: an outcome analysis from a tertiary care institute. Lasers Med Sci 2020; 36:521-528. [PMID: 32494979 DOI: 10.1007/s10103-020-03051-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Transurethral endoscopic incision is an established treatment option for management of obstructing ureterocele. It can be performed using monopolar electrocautery or holmium laser as an energy source. The present study was carried out to evaluate outcomes of transurethral ureterocele incision (TUI) by two different energy sources, i.e., monopolar electrocautery versus holmium laser. A retrospective review of the data of all patients who underwent endoscopic TUI from 2007-2017 was performed. Preoperative clinical, biochemical, and radiological characteristics and operative parameters were reviewed and compared between the two groups. Associated stone in the ureterocele was fragmented using pneumatic lithotripter or Mauermeyer stone punch forceps in the electrocautery group and holmium laser in the laser group. Statistical analysis was performed using IBM SPSS version 21.0. Chi-squared test was used for categorical/dichotomous variables. Unpaired t test was used for continuous variables. Out of total 44 patients, 28 patients had duplex system ureterocele and 16 patients had single system ureterocele. Mean age was 18.5 + 7.4 years (range 14-26 years). Six patients had associated stones in the ureterocele. Most common presentation was flank pain followed by urinary infections and bladder outlet obstruction. Preoperative vesico-ureteric reflux was seen in 18% patients. Monopolar TUI was performed in 20 patients and laser-TUI in 24 patients. Three patients had associated stone in ureterocele in each group. Fragmentation of stone was successfully done with holmium laser without changing the instrument and with less associated surgical morbidity in the laser group. Postoperative successful decompression was evident in 38 (90%) patients. Renal parenchyma thickness was improved on ultrasound scan and renal scan showed non-obstructed system in all patients at follow-up. Both laser and monopolar incision have similar efficacy in decompressing the ureterocele in long-term follow-up. However, laser has added advantage of stone lithotripsy with the same instruments with lesser morbidity and lower incidence of persistent reflux.
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Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems. World J Urol 2019; 37:2237-2244. [DOI: 10.1007/s00345-018-2607-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022] Open
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Caione P, Gerocarni Nappo S, Collura G, Matarazzo E, Bada M, Del Prete L, Innocenzi M, Mele E, Capozza N. Minimally Invasive Laser Treatment of Ureterocele. Front Pediatr 2019; 7:106. [PMID: 31024867 PMCID: PMC6463783 DOI: 10.3389/fped.2019.00106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction: Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy. Materials and methods: Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5-0.8 joule energy, through 8-9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18-24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6-18 months in selected cases. Statistical analysis was utilized for data evaluation. Results: From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1-168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6-18 months follow-up for recurrent dilatation. Urinary tract infections and de novo refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls (p < 0.05). Further surgery was required in 12 patients (18%) at 1-5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group (p < 0.05). Conclusions: Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery.
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Affiliation(s)
- Paolo Caione
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Simona Gerocarni Nappo
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Giuseppe Collura
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Ennio Matarazzo
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Maida Bada
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Laura Del Prete
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Michele Innocenzi
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Ermelinda Mele
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Nicola Capozza
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
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Abstract
There has been renewed interest in the use of lasers for minimally invasive treatment of urologic diseases in recent years. The introduction of more compact, higher power, less expensive and more user-friendly solid-state lasers, such as the holmium:yttrium-aluminum-garnet (YAG), frequency-doubled neodymium:YAG and diode lasers has made the technology more attractive for clinical use. The availability of small, flexible, biocompatible, inexpensive and disposable silica optical fiber delivery systems for use in flexible endoscopes has also promoted the development of new laser procedures. The holmium:YAG laser is currently the workhorse laser in urology since it can be used for multiple soft- and hard-tissue applications, including laser lithotripsy, benign prostate hyperplasia, bladder tumors and strictures. More recently, higher power potassium-titanyl-phosphate lasers have been introduced and show promise for the treatment of benign prostatic hyperplasia. On the horizon, newer and more effective photosensitizing drugs are being tested for potential use in photodynamic therapy of bladder and prostate cancer. Additionally, new experimental lasers such as the erbium:YAG, Thulium and Thulium fiber lasers, may provide more precise incision of soft tissues, more efficient laser lithotripsy and more rapid prostate ablation. This review provides an update on the most important new clinical and experimental therapeutic applications of lasers in urology over the past 5 years.
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Affiliation(s)
- Nathaniel M Fried
- Johns Hopkins University School of Medicine, James Buchanan Brady Urological Institute, Biophotonics Laboratory, Baltimore, MD 21224, USA.
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Kajbafzadeh A, Salmasi AH, Payabvash S, Arshadi H, Akbari HR, Moosavi S. Evolution of Endoscopic Management of Ectopic Ureterocele: A New Approach. J Urol 2007; 177:1118-23; discussion 1123. [PMID: 17296426 DOI: 10.1016/j.juro.2006.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE We report the evolution of endoscopic treatment of ectopic ureteroceles from the unroofing technique to a novel approach using concomitant ureterocele double puncture and intraureterocele fulguration. We also compare the results of different endoscopic modalities at a single center. MATERIALS AND METHODS We reviewed the records of 46 children with ectopic ureteroceles who were treated endoscopically between 1995 and 2005. The patients were divided into 2 main groups. Group 1 included 17 patients who underwent common endoscopic treatments, including ureterocele incision (4 patients), single ureterocele puncture (4), and single puncture with insertion of a Double-J stent (9). Group 2 included 29 children who underwent ureterocele double puncture and fulguration of the anterior and posterior walls of the collapsed ureterocele after insertion of a Double-J stent into both punctured sites. We also managed concomitant vesicoureteral reflux by endoscopic injection of tricalcium phosphate ceramic into the subureteral region. RESULTS Total success rates in group 1 were 0%, 25% and 33% in patients who underwent ureterocele incision, single ureterocele puncture and single puncture with insertion of a stent, respectively. Total success rate in group 2 was 90% (p<0.05). New onset vesicoureteral reflux developed in 8 patients (47%) in group 1, of which 6 were in ureterocele moieties, and in 8 patients (28%) in group 2, with none in a ureterocele moiety (p<0.01). A total of 13 patients (76%) in group 1 required open surgical intervention, compared to 3 (10%) in group 2 (p<0.05). CONCLUSIONS This new endoscopic approach is highly effective in the treatment of children with ectopic ureteroceles.
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Affiliation(s)
- Abdolmohammad Kajbafzadeh
- Department of Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Hubert KC, Palmer JS. Current diagnosis and management of fetal genitourinary abnormalities. Urol Clin North Am 2007; 34:89-101. [PMID: 17145364 DOI: 10.1016/j.ucl.2006.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prenatal assessment with ultrasonography provides excellent imaging of fluid-filled structures (eg, hydronephrosis, renal cysts, and dilated bladder) and renal parenchyma. This information allows for the generation of a differential diagnosis, identification of associated anomalies, and assessment of the prenatal and postnatal risks of a given anomaly. This enhances parental education and prenatal and postnatal planning. This article discusses the current methods of diagnosis and management of fetal genitourinary anomalies, and also the postnatal evaluation and treatment of these conditions.
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Affiliation(s)
- Katherine C Hubert
- Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Jankowski JT, Palmer JS. Holmium: yttrium-aluminum-garnet laser puncture of ureteroceles in neonatal period. Urology 2006; 68:179-81. [PMID: 16806429 DOI: 10.1016/j.urology.2006.01.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 12/26/2005] [Accepted: 01/27/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The use of the holmium:yttrium-aluminum-garnet (YAG) laser to incise a ureterocele in children has been reported. However, its use to puncture ureteroceles in neonates has not. Therefore, we evaluated the effectiveness and safety of ureterocele puncture using a holmium-YAG laser in neonatal patients. METHODS We reviewed our experience of all neonates (ie, children younger than 28 days old) who underwent transurethral puncture of a ureterocele. The preoperative data collected included age at presentation, mode of presentation, ureterocele location, and weight and age at the procedure. A holmium:YAG laser was used to incise the ureterocele, and a 200, 365, or 550-microm laser fiber was passed through a 6F or 7.5F cystoscope. RESULTS A total of 4 neonates (2 boys and 2 girls) underwent transurethral holmium laser puncture of five ureteroceles. All patients were initially diagnosed with prenatal ultrasound findings confirmed after birth with additional imaging. The mean age at the initial puncture was 13.8 days, with a mean patient weight of 3.9 kg. The mean follow-up was 2.8 years (range 1.7 to 3.4). Four (80%) of five ureteroceles were adequately decompressed after one attempt. One patient required a second puncture of the ureterocele at 46 days of age because of incomplete decompression. None of the patients experienced an intraoperative or postoperative complication, including new vesicoureteral reflux after laser puncture. CONCLUSIONS Holmium:YAG laser puncture of ureterocele is a safe, efficacious, and viable option for children in the neonatal period. However, this technique in these young children requires additional evaluation.
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Affiliation(s)
- Jason T Jankowski
- Division of Pediatric Urology, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
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Futao S, Wentong Z, Yan Z, Qingyu D, Aiwu L. Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients. Pediatr Surg Int 2006; 22:514-8. [PMID: 16736220 DOI: 10.1007/s00383-006-1692-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2006] [Indexed: 10/24/2022]
Abstract
Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser incision is a new method applied in pediatric urology recent years. To evaluate its therapeutic efficacy on treating the pediatric patients with urethral strictures and urethral atresias, a retrospective study was performed from June 2001 to July 2005 in a total of 28 pediatric patients who underwent endoscopic internal urethrotomy using Ho:YAG laser in our center. In these patients, 25 had urethral strictures and 3 urethral atresias. Follow-up was done ranging from 2 months to 4 years to assess the treatment. Of the 28 patients, 25 (89.3%) have achieved satisfied result without complications following initial incisions. Two patients with urethral atresias and another with long lesion of stricture (> 2 cm) have postoperative stenosis (10.7%). Among the three reoccurred patients, two were successfully reoperated by Ho:YAG laser and open end-to-end anastomosis, respectively. One patient failed to follow-up. With the advantages of safety, efficacy and minimal invasion, endoscopic Ho:YAG laser incision technique could be used as a primary treatment in urethral stricture patients and is worthy to be popularized further in pediatric surgery.
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Affiliation(s)
- Sun Futao
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, 107# West Culture Road, Jinan City, 250012, China.
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Ben Meir D, Silva CJTDAE, Rao P, Chiang D, Dewan PA. DOES THE ENDOSCOPIC TECHNIQUE OF URETEROCELE INCISION MATTER? J Urol 2004; 172:684-6. [PMID: 15247761 DOI: 10.1097/01.ju.0000129228.92805.31] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Endoscopic ureterocele decompression is a well established procedure in children. However, an accurate endoscopic incision may be challenging in large ectopic ureteroceles. We describe a percutaneously assisted technique to facilitate the ease of ureterocele incision and review other described methods. MATERIALS AND METHODS We reviewed the medical records of 12 children with ectopic ureteroceles subtending a double collecting system who underwent endoscopic, percutaneously assisted incision. Six ureteroceles were on the left side, 5 were on the right side and 1 child had bilateral ureteroceles. Decompression results were evaluated by ultrasound and Tc-mercaptoacetyltriglycine imaging during a mean of 2.8 years of followup. RESULTS There were 7 girls and 5 boys. Mean age at presentation was 11.6 months (range 1 week to 6 years). The decompression success rate was 84% (11 of 13 renal units), and improved renal function and drainage was noted in 5 of 12 patients (41.6%). Seven of 12 patients had vesicoureteral reflux, of whom 2 were asymptomatic at followup and, hence, were treated conservatively. Five children underwent surgery because of recurrent urinary tract infections. CONCLUSIONS Although our results are similar to those of other methods, percutaneously assisted cystoscopic incision of ureterocele enables easier and more accurate decompression. However, when comparing the various techniques described, it seems that postoperative results mostly reflect the anatomical and functional characteristics of the urinary system rather than the technique used.
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Affiliation(s)
- D Ben Meir
- Paediatric Urology Unit, Sunshine Hospital, Parkville, Victoria, Australia
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Montorsi F, Althof SE, Sweeney M, Menchini-Fabris F, Sasso F, Giuliano F. Treatment satisfaction in patients with erectile dysfunction switching from prostaglandin E1 intracavernosal injection therapy to oral sildenafil citrate. Int J Impot Res 2003; 15:444-9. [PMID: 14671665 DOI: 10.1038/sj.ijir.3901049] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Treatment satisfaction, subanalysed by demographic variables, was evaluated in patients switching from successful intracavernosal prostaglandin E(1) (PGE(1)) therapy to oral sildenafil citrate. The validated Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire was administered at the end of PGE(1) therapy and after 12 weeks of sildenafil treatment in a multicentre, open-label study. Men with erectile dysfunction (n=176) who were switched from stable PGE(1) therapy to sildenafil (25-100 mg) were equally satisfied with onset of action, duration of action, and confidence in ability to engage in sexual activity, but expressed greater overall treatment satisfaction with sildenafil (P<0.01), better ease of use (P<0.001), naturalness of erectile process (P<0.001), and intention to continue treatment (P<0.001). Partners (n=32) were overall more satisfied with sildenafil (P<0.05), and their responses correlated with patient satisfaction (r=0.68). Compared with PGE(1) injection, these data suggest that patients may be less likely to discontinue taking sildenafil treatment for their erectile dysfunction.
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Affiliation(s)
- F Montorsi
- Department of Urology, Universita' Vita Salute San Raffaele, Milan, Italy.
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Chertin B, de Caluwé D, Puri P. Is primary endoscopic puncture of ureterocele a long-term effective procedure? J Pediatr Surg 2003; 38:116-9; discussion 116-9. [PMID: 12592632 DOI: 10.1053/jpsu.2003.50023] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE For more than a decade, endoscopic puncture of ureterocele has been recommended as an initial and, in the majority of the patients, as a definitive procedure. This study evaluates the long-term effectiveness of primary endoscopic puncture of ureterocele. METHODS Over the last 18 years (1984 through 2001), 52 patients (median age 3 months) underwent primary endoscopic puncture of ureterocele. The median follow-up was 9 years (6 months to 18 years). Antenatal ultrasound scan detected hydronephrosis and led to the postnatal diagnosis of ureterocele in 12 (23%) children, whereas in the remaining 40 (77%) children the diagnosis was made on investigation for urinary tract infection (UTI). The ureterocele presented as a part of renal duplication in 48 (92%) patients and a single system in 4 (8%). Forty-four (92%) of the patients with duplication presented with non- or poorly functioning upper poles. Vesicoureteric reflux (VUR) was seen in the lower moiety of the ipsilateral kidney in 31 and in 18 of the contralateral kidney comprising 49 renal refluxing units (RRU). RESULTS Complete decompression of the ureterocele was achieved in 48 (92%) patients after the first endoscopic puncture. Four (8%) patients required a second puncture of ureterocele. Nine (17%) of the 52 patients underwent nephrectomy for a nonfunctioning kidney. Ten (19%) patients required upper pole partial nephrectomy owing to nonfunctioning upper pole. Twenty-nine (59%) of the 49 RRU showed spontaneous resolution of VUR. Sixteen (33%) RRU underwent endoscopic correction of VUR. One required ureteric reimplantation. The remaining 4 (8%) are maintained on prophylactic antibiotics. Five (10%) patients had VUR in the upper pole moieties after ureterocele puncture. CONCLUSIONS Our data suggest that primary endoscopic puncture of ureteroceles is a simple, long-term, effective, and safe procedure avoiding complete reconstruction in the majority of the patients.
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Affiliation(s)
- Boris Chertin
- Children's Research Centre of Our Lady's Hospital for Sick Children, University College Dublin, Crumlin, Dublin, Ireland
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