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Zhang Y, Zhang Y, Jiang J, Zhang K, Sun Q, Chao M. Clinical outcomes and risk factor analysis of early endoscopic puncture decompression for ureterocele associated with duplex kidney in children: a single-center retrospective study. Int Urol Nephrol 2023; 55:2373-2379. [PMID: 37393384 PMCID: PMC10499972 DOI: 10.1007/s11255-023-03694-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/25/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The aims of this study were to analyze the clinical outcomes of treating duplex system ureteroceles with early endoscopic puncture decompression and to identify the risk factors related to outcomes to help guide future work. MATERIALS AND METHODS We retrospectively reviewed the clinical records of patients with ureteroceles with duplex kidney that were treated with early endoscopic puncture decompression. Charts were reviewed for demographics, preoperative imaging, surgical indications, and follow-up data. Recurrent febrile urinary tract infections (fUTIs), de novo vesicoureteral reflux (VUR), persistent high-grade VUR, unrelieved hydroureteronephrosis, and the need for further intervention were considered unfavorable outcomes. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), type of ureterocele, ipsilateral VUR diagnosed before surgery, simultaneously upper-pole moiety (UM) and lower-pole moiety (LM) obstruction, the width of ureter affiliated to UM, and maximum diameter of ureterocele were all considered potential risk factors. A binary logistic regression model was used to identify the risk factors of unfavorable outcomes. RESULTS A total of 36 patients with ureteroceles related to duplex kidney underwent endoscopic holmium laser puncture from 2015 to 2023 at our institution. After a median follow-up of 21.6 months, unfavorable outcomes developed in 17 patients (47.2%). Three patients underwent ipsilateral common-sheath ureter reimplantation and one patient underwent laparoscopic ipsilateral upper to lower ureteroureterostomy combined with recipient ureter reimplantation. Three patients underwent laparoscopic upper-pole nephrectomy. Fifteen patients suffered from recurrent UTIs were treated with oral antibiotics and eight of them were diagnosed de novo VUR according to voiding cystourethrography (VCUG). In univariate analysis, patients with simultaneously UM and LM obstruction (P = 0.003), fUTIs before surgery (P = 0.044), and ectopic ureterocele (P = 0.031) were more likely to have unfavorable outcomes. Binary logistic regression analysis showed that ectopic ureterocele (OR = 10.793, 95% CI 1.248-93.312, P = 0.031) and simultaneously UM and LM obstruction (OR = 8.304, 95% CI 1.311-52.589, P = 0.025) were identified as independent factors for unfavorable outcomes. CONCLUSIONS Our study suggested that early endoscopic puncture decompression is not a preferred but an available treatment option to release BOO or to cure refractory UTIs. It was easier to fail if the ureterocele was ectopic or simultaneously UM and LM obstruction existed. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), ipsilateral VUR diagnosed before surgery, the width of ureter affiliated to UM, and maximum diameter of ureterocele were not significantly related to the success rate of early endoscopic punctures.
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Affiliation(s)
- Ye Zhang
- Anhui Provincial Children's Hospital, Anhui, China
| | - Yin Zhang
- Anhui Provincial Children's Hospital, Anhui, China
| | - Jiabin Jiang
- Anhui Provincial Children's Hospital, Anhui, China
| | | | - Qihang Sun
- Anhui Provincial Children's Hospital, Anhui, China
| | - Min Chao
- Anhui Provincial Children's Hospital, Anhui, China.
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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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Song SH, Lee DH, Kim H, Lee J, Lee S, Ahn D, Park S, Kim KS. Impact of de novo vesicoureteral reflux on transurethral surgery outcomes in pediatric patients with ureteroceles. Investig Clin Urol 2019; 60:295-302. [PMID: 31294139 PMCID: PMC6607067 DOI: 10.4111/icu.2019.60.4.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/28/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose We aimed to determine the impact of de novo vesicoureteral reflux (VUR) on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles. Materials and Methods We retrospectively reviewed the medical records of 34 patients (36 renal units) with ureteroceles that were treated endoscopically. Perioperative radiologic and clinical data regarding de novo VUR, UTI, and renal function were analyzed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, and deterioration of renal function. Results Of the 36 renal units, 22 had a duplex system (61.1%). Preoperative VUR was noted in 9 units (25.0%), including 3 units without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 28 units (77.8%). De novo VUR developed in 18 renal units (50.0%) postoperatively. The absence or presence of de novo VUR was not related to unfavorable surgical outcomes in univariate or multivariate analyses. Even after selection for the 28 renal units without preoperative VUR, the occurrence of de novo VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 14 renal units without renal duplication, de novo VUR had no predictive value for any of these adverse outcomes. Conclusions After endoscopic ureterocele puncture, de novo VUR is not significantly associated with postoperative UTI or deterioration in renal function in the long term. It may not, therefore, be necessary to reconstruct lower urinary tract routinely to correct de novo VUR after endoscopic puncture of the ureterocele.
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Affiliation(s)
- Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwiwoo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jongpil Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sangmin Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Donghyun Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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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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Adult Bilateral Ureteroceles Presenting with Lower Urinary Tract Symptoms and Acute Urinary Retention. Case Rep Urol 2018; 2018:3186060. [PMID: 30046505 PMCID: PMC6038490 DOI: 10.1155/2018/3186060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
Ureterocele is a well-known pathologic entity in the pediatric urology population but remains a diagnostic and treatment challenge in the adult population. Adult ureteroceles remain a diagnostic challenge for the adult urologist. Its prevalence is estimated between 1/500 and 1/4000 patients with a wide variety of clinical presentations. We present the case of a 30-year-old female patient who presented with severe lower urinary tract symptoms (LUTS) and acute urinary retention secondary to prolapsing bilateral single-system orthotopic ureteroceles. She was successfully treated with transurethral unroofing of her bilateral ureteroceles and she is currently asymptomatic. This case represents the first reported case of bilateral ureteroceles presenting with severe LUTS and subsequent urinary retention from the prolapse of one of the ureteroceles. We provide a review of the most recent case series of adult ureteroceles and their outcomes. Transurethral unroofing of the ureterocele is a safe and minimally invasive approach for this disease.
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Andrioli V, Guerra L, Keays M, Keefe DT, Tang K, Sullivan KJ, Garland K, Rafikov M, Leonard MP. Active surveillance for antenatally detected ureteroceles: Predictors of success. J Pediatr Urol 2018; 14:243.e1-243.e6. [PMID: 29580731 DOI: 10.1016/j.jpurol.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Historically, ureteroceles were surgically treated, as patients were diagnosed after developing symptoms. However, with the advance of fetal medicine, antenatal detection has provided an opportunity to look at the natural history of ureteroceles. OBJECTIVES With data derived from a retrospective chart review of patients with ureteroceles that were detected antenatally, the current study aimed to determine which group of children would be at risk for failure on active surveillance. It was hypothesized that single system ureteroceles (SSU) and male patients with duplex system ureteroceles (DSU) would be ideal for observation. METHODS Outcomes were assessed by descriptive statistics. Kaplan-Meier curves were utilized to estimate median duration on active surveillance in both single and duplex cohorts. Breakthrough febrile urinary tract infection (fUTI) and surgery were determined by Cox regression in the duplex system cohort. Surgery was considered surveillance failure. RESULTS A total of 102 patients (64 females/38 males) met the criteria: 78 (76.5%) had DSU and 24 (23.5%) SSU. The overall median observation was 1.2 years (range 0.7-3.1). Follow-up ranged from 0.3 to 11.7 years for SSU, and from 0.02 to 17.3 years for DSU. The predictors of failure of active surveillance (AS) in DSU (surgical intervention) were male gender (HR 1.8, 1.0-3.3, P = 0.037), or fUTI (HR 3.1, 1.7-5.8, P = 0.002). Predictors of fUTI were contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter (OR 9.5, 1.2-71.7, P = 0.028). Interestingly, vesicoureteral reflux (VUR) was not a predictor of fUTI. The SSU patients were ideal for AS, while in DSU, surveillance was successful in 30% of patients who were primarily females without contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter. However, in contradiction to the hypothesis, males were at higher risk for surgical intervention in the DSU cohort. CONCLUSION Active surveillance is an option for patients with antenatally detected ureteroceles, but careful long term follow up is mandatory. Parents should be advised that surgical intervention may still be necessary, particularly in males with DSU.
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Affiliation(s)
- V Andrioli
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - L Guerra
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - M Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - D T Keefe
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - K Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - K J Sullivan
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - K Garland
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - M Rafikov
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - M P Leonard
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
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Hodhod A, Noureldin YA, El-Sherbiny M. Is transurethral incision better than upper pole partial nephrectomy for management of duplex system ureterocoele diagnosed in the first year of life? Arab J Urol 2017; 15:319-325. [PMID: 29234535 PMCID: PMC5717465 DOI: 10.1016/j.aju.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 06/15/2017] [Accepted: 08/10/2017] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the outcomes of transurethral incision (TUI) and upper pole partial nephrectomy (PN) in patients with duplex system ureterocoele (DSU). Patients and methods We retrospectively reviewed the medical charts of patients who presented with DSU in the first-year of life and were managed with either TUI or PN. Patients’ demographics, ultrasonography examinations, voiding cystourethrogram studies, and dimercaptosuccinic acid scans were reviewed. Also, the postoperative vesico-ureteric reflux status and febrile urinary tract infection occurrences, and subsequent surgical interventions were identified. The outcomes for the DSU location (intravesical vs extravesical) were compared. Results Between January 1995 and September 2015, 44 patients underwent TUI (31 patients) or PN (13). The TUI patients presented at a median age of 1.1 months and were followed-up for a median of 47.4 months, whilst those who underwent PN presented at a median age of 1.06 months and were followed-up for a median of 44.23 months. Postoperatively, in the TUI group, four of 15 units had improved renal function and 11 units had stable function. In the PN group, five of nine units had stable renal function and the remaining four had worsened function (P = 0.019). Furthermore, 15 of the 31 patients (48%) in the TUI group required second interventions compared with one of 13 patients in the PN group (P = 0.01). There was no significant difference between the outcomes of intravesical and extravesical DSUs after TUI and PN. Conclusion This study shows significant renal function preservation with TUI compared to PN. However, secondary surgical interventions were higher with TUI.
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Affiliation(s)
- Amr Hodhod
- Division of Urology, McGill University, Montréal, Québec, Canada.,Department of Urology, Faculty of Medicine, Menoufia University, Al Minufya, Egypt
| | - Yasser A Noureldin
- Division of Urology, McGill University, Montréal, Québec, Canada.,Department of Urology, Benha Faculty of medicine, Benha University, Al Qalyubia, Egypt
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Chowdhary SK, Kandpal DK, Sibal A, Srivastava RN, Vasudev AS. Ureterocele in newborns, infants and children: Ten year prospective study with primary endoscopic deroofing and double J (DJ) stenting. J Pediatr Surg 2017; 52:569-573. [PMID: 27637141 DOI: 10.1016/j.jpedsurg.2016.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/14/2016] [Accepted: 08/23/2016] [Indexed: 10/21/2022]
Abstract
AIM To evaluate the success of endoscopic deroofing with double J (DJ) stenting as a primary treatment modality of uncomplicated ureterocele. PATIENTS AND METHODS All babies with uncomplicated ureterocele referred to us between 2005 and 2015 were to be prospectively recruited into the study without any exception. The preoperative management would include ultrasound KUB on a fixed protocol, micturating cystourethrogram, DTPA scan and MRU (magnetic resonance urography) or IVP (intravenous pyelography). Those who had non-obstructing ureterocele were to be followed conservatively. The indications for operative intervention were to be obstructed ureterocele, bladder outlet obstruction, recurrent UTI or progressive renal scarring. They were then to be taken for cystoscopy in diuretic phase for endoscopic deroofing and DJ stenting with 9F resectoscope. Four weeks later, the DJ stent was to be removed after examining the deroofing in each patient. They were then followed up for future development of symptoms and need for secondary surgery with anatomical and functional imaging as necessary. RESULTS Forty three consecutive patients (47 ureterocele units) with ureterocele were recruited into the study between 2005 and 2015. Thirty four patients were managed by endoscopic first approach with ureterocele deroofing and DJ stenting. Four babies were asymptomatic and did not show obstructed drainage pattern on DTPA and hence were managed conservatively and kept on follow-up. Four patients underwent primary open surgery and reconstruction because of presentation with complications. ECTOPIC URETEROCELE There were 17 patients with ectopic ureterocele. Thirteen underwent primary endoscopic deroofing. Three underwent open surgery and one underwent robotic bilateral ureterocele excision and ureteric reimplantation. Eight children out of thirteen are completely asymptomatic after the endoscopic incision. On ultrasound evaluation 8/13 have resolution of the hydronephrosis and 5/13 have stable hydronephrosis with no increase in dilatation. None of these 13 children have required a second endoscopic procedure for inadequate decompression of the ureterocele. None of the 13 patients have any voiding difficulty or incontinence. 2/13 cases with recurrent UTI and persistent symptoms, required secondary surgery. This constituted 15% secondary surgery in the ectopic ureterocele category. ORTHOTOPIC URETEROCELE There were 21 patients out of 22 with orthotopic ureterocele who underwent endoscopic deroofing. Six out of these 21 patients had episodes of UTI, of which three had resolution of the reflux and two had downgrading of reflux. One child continued to have recurrent UTI and needed a laparoscopic nephroureterectomy. Eighteen children are completely asymptomatic after the initial endoscopic deroofing. The rate of secondary surgery was 4.7% in orthotopic ureterocele group, where nearly 50% have more than five years follow-up. None of our patients who are more than five years, have had any urinary incontinence or voiding dysfunction. All patients remain on follow-up from 6months to 10years (median 5years). CONCLUSION At this stage of our study with median follow-up of 5years (6months-10years), we suggest that primary endoscopic deroofing with DJ stenting for obstructing ureterocele is the best initial approach for adequate decompression and reducing the rate of secondary surgery.
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Affiliation(s)
- Sujit K Chowdhary
- Department of Pediatric Urology & Pediatric Surgery, Indraprastha Apollo Hospital, New Delhi, India.
| | - Deepak K Kandpal
- Department of Pediatric Urology & Pediatric Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Anupam Sibal
- Department of Pediatric Urology & Pediatric Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Rajendra N Srivastava
- Department of Pediatric Urology & Pediatric Surgery, Indraprastha Apollo Hospital, New Delhi, India
| | - Anand S Vasudev
- Department of Pediatric Urology & Pediatric Surgery, Indraprastha Apollo Hospital, New Delhi, India
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Evaluation of the Initial Treatment of Ureteroceles. Urology 2016; 89:113-7. [DOI: 10.1016/j.urology.2015.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022]
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Chowdhary SK, Kandpal DK, Sibal A, Srivastava RN. Management of complicated ureteroceles: Different modalities of treatment and long-term outcome. J Indian Assoc Pediatr Surg 2014; 19:156-61. [PMID: 25197194 PMCID: PMC4155633 DOI: 10.4103/0971-9261.136471] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The presentation and management of ureterocele has been rarely reported from India and is limited to an odd case report. They can be detected antenatally, may have incidental diagnosis or present with consequences of obstructive uropathy. They always present with secondary complications in adulthood, if the diagnosis and treatment is missed in early years of life. The natural history may be particularly disastrous in cases of bilateral obstructing ureterocele. The complications secondary to obstructive ureterocele can be urinary retention, pyonephrosis, urosepsis, stones and even chronic renal failure. Each of these patients needs an individualized treatment plan. In the period 2003-2013, we managed 36 consecutive patients with varied presentation of this entity. All were managed on the basis of a fixed protocol of investigation and operative intervention. Ultrasound, micturating cystourethrogram, isotope renogram were done preoperatively in all the babies. Those with asymptomatic, unobstructed ureteroceles were left without any intervention. Simple or complex intravesical ureteroceles underwent examination under anesthesia and endoscopic deroofing and DJ stenting for 3 weeks. Of a total of 36 children, 6 were presented with acute complications of ureterocele. They have been managed on an individualized optimum management plan. Their management approach with follow-up is being reported as there is no previous reported series on ureterocele in children from our country.
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Affiliation(s)
- Sujit K Chowdhary
- Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Deepak K Kandpal
- Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Anupam Sibal
- Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - Rajendra N Srivastava
- Department of Pediatric Urology and Pediatric Surgery, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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Mariyappa B, Barker A, Samnakay N, Khosa J. Management of duplex-system ureterocele. J Paediatr Child Health 2014; 50:96-9. [PMID: 24372828 DOI: 10.1111/jpc.12474] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
AIM To analyse different treatment modalities, functional outcome and continence in children treated for duplex-system ureterocele and to review the relevant literature. METHODS The medical records of patients with duplex-system ureterocele treated between 2001 and 2011 were reviewed retrospectively. RESULTS Twenty-two cases were identified. Five patients underwent incision of the ureterocele as initial procedure. It was curative in only one patient. Seven patients underwent upper-pole nephroureterectomy. It was curative in 4 cases. Five patients underwent excision of ureterocele and common-sheath reimplant, and the remaining 5 patients had upper-pole nephroureterectomy and simultaneous excision of ureterocele with lower-moiety ureteric reimplantation. These surgeries were curative in all patients. Follow-up ranged from 4 to 84 months. Functional outcome was good in all patients. Fourteen patients were continent at follow-up, and continence was not assessed in the other 8 because of young age. CONCLUSIONS Our data suggest a higher rate of secondary procedures if there is retained ureterocele. Data also suggest that complete reconstruction can be safely performed in a young infant without any adverse effect on continence.
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Affiliation(s)
- Bhanu Mariyappa
- Department of Paediatric Surgery, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
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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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Adiego B, Martinez-Ten P, Perez-Pedregosa J, Illescas T, Barron E, Wong AE, Sepulveda W. Antenatally diagnosed renal duplex anomalies: sonographic features and long-term postnatal outcome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:809-815. [PMID: 21632996 DOI: 10.7863/jum.2011.30.6.809] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purpose of this study was to assess the diagnostic accuracy and infant outcomes of antenatally detected renal duplex anomalies. METHODS An observational longitudinal study of cases of renal duplex anomalies diagnosed on prenatal sonography was conducted. Information on the prenatal sonographic findings, antenatal course, and perinatal outcome was obtained by reviewing the sonography reports and delivery records. Postnatal follow-up, including neonatal and infant evaluations, was obtained from hospital records. RESULTS During a 7-year period, a total of 24 cases of renal duplex anomalies were identified prenatally. Three cases were excluded from subsequent analysis because of termination of pregnancy after the diagnosis of a severe brain abnormality, loss to follow-up, and an inability to confirm the prenatal diagnosis on neonatal renal sonography. Among the 21 confirmed cases, the presence of two separate renal pelvises was the most common prenatal sonographic feature (n = 15 [71%]), followed by dilatation of a single moiety with a dilated ipsilateral ureter or ureterocele (n = 6 [29%]). In 43% of cases, the renal duplex anomalies had no adverse associations, but in 48%, they were complicated by a urinary tract infection, and 48% of the infants required a surgical procedure during early childhood. CONCLUSIONS Renal duplex anomalies can be accurately diagnosed by prenatal sonography even when there is minimal dilatation of the renal pelvis. Antenatal diagnosis allows planning of postnatal care, which may prevent urinary tract infections and renal function impairment. The natural history of antenatally diagnosed duplex anomalies seems to be overall benign, with urinary tract infections and the need for surgery being the most common complications in affected infants.
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Affiliation(s)
- Begoña Adiego
- Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology, Paseo de la Habana 204, Bajo-1, 28036 Madrid, Spain.
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Adorisio O, Elia A, Landi L, Taverna M, Malvasio V, Danti AD. Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System. Urology 2011; 77:191-4. [DOI: 10.1016/j.urology.2010.02.061] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 02/23/2010] [Accepted: 02/23/2010] [Indexed: 11/24/2022]
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Abstract
Vesicoureteral reflux (VUR) is the most common anomaly associated with duplex systems. In addition to an uncomplicated duplex system, reflux can also be secondary in the presence of an ectopic ureterocele with duplex systems. Controversy exists in regard to the initial and most definitive management of these anomalies when they coexist. This paper will highlight what is currently known about duplex systems and VUR, and will attempt to provide evidence supporting the various surgical approaches to an ectopic ureterocele and duplex system and the implications of concomitant VUR.
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Chertin B, Mohanan N, Farkas A, Puri P. Endoscopic Treatment of Vesicoureteral Reflux Associated With Ureterocele. J Urol 2007; 178:1594-7. [PMID: 17707044 DOI: 10.1016/j.juro.2007.03.170] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE We determined the value of endoscopic treatment for vesicoureteral reflux associated with ureterocele. MATERIALS AND METHODS From 1984 to 2005, 109 children with a median age of 6 months underwent endoscopic ureterocele puncture. Ureterocele presented as a part of a duplex system in 97 of patients (89%) and as part of a single system in 12 (11%). Vesicoureteral reflux was seen to the lower ipsilateral moiety in 53 patients and in 32 contralateral kidneys (85 refluxing renal units). Puncture was performed with a 3Fr Bugbee electrode. High grade vesicoureteral reflux or breakthrough infection while on antibiotic prophylaxis served as the indication for the surgical correction of vesicoureteral reflux. Median followup after endoscopic correction was 10 years (range 1 to 21). RESULTS Spontaneous vesicoureteral reflux resolution following successful ureterocele puncture was seen in 36 of the 85 refluxing renal units (42%) and in 5 (6%) reflux was downgraded. The latter patients were withdrawn from antibiotic prophylaxis and they did well. A total of 33 refluxing renal units with vesicoureteral reflux into the lower moiety of the ureterocele kidney and 11 contralateral refluxing renal units underwent endoscopic correction. Reflux was corrected in 31 of the 44 refluxing renal units (70%) after a single injection and it resolved after a second injection in another 9 (21%). In 4 refluxing renal units (9%) endoscopic correction failed and open reimplantation was done. Of the 109 patients (13%) 14 had vesicoureteral reflux to the ureterocele moiety following endoscopic puncture. Of those patients endoscopic correction resolved reflux in 3, reflux resolved spontaneously in 5 and upper pole partial nephrectomy was performed in 4 due to a nonfunctioning moiety. The remaining 2 patients did well without antibiotic prophylaxis. CONCLUSIONS Our data show that endoscopic treatment of vesicoureteral reflux associated with ureterocele is a simple, long-term effective and safe procedure, avoiding the need for open surgery in the majority of patients following endoscopic puncture of ureterocele.
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Affiliation(s)
- Boris Chertin
- Department of Urology, Shaare Zedek Medical Centre, Jerusalem.
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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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Ziylan O, Oktar T, Korgali E, Nane I, Alp T, Ander H. Lower Urinary Tract Reconstruction in Ectopic Ureteroceles. Urol Int 2005; 74:123-6. [PMID: 15756063 DOI: 10.1159/000083282] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 10/28/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The management of ectopic ureteroceles is a challenging entity in pediatric urology. In our study, we aimed to determine the outcome after lower urinary tract reconstruction in ectopic ureteroceles. MATERIALS AND METHODS A total of 18 (12 girls, 6 boys) children with ectopic ureteroceles, treated between 1993 and 2003 by complete reconstruction, were enrolled in the study and their records were retrospectively reviewed. RESULTS Ureterocele was found to be unilateral in 16 and bilateral in 2 children. Four patients had been previously managed by endoscopic interventions and 1 patient underwent partial nephrectomy. Ureterocelectomy was performed on 20 renal units, and of these 20 renal units, 9 underwent heminephroureterectomy, 1 ureterectomy, and 3 (with single system ureteroceles) nephroureterectomy. Seven (35%) renal units with adequate function underwent ureteral reimplantations. After a mean follow-up of 5.4 years (range 4 months to 9.5 years), no patient required a second procedure. Contralateral reflux that developed in 2 children after surgical treatment resolved spontaneously after 1 year of follow-up. CONCLUSION In the management of ectopic ureterocele, lower urinary tract reconstruction is an effective treatment alternative. According to the functional status of the renal parenchyma involved, the surgical procedure was limited to the lower urinary tract in 35% of the cases.
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Affiliation(s)
- Orhan Ziylan
- Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
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Castagnetti M, Cimador M, Sergio M, de Grazia E. Transurethral incision of duplex system ureteroceles in neonates: does it increase the need for secondary surgery in intravesical and ectopic cases? BJU Int 2004; 93:1313-7. [PMID: 15180630 DOI: 10.1111/j.1464-410x.2004.04861.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the relevance of ureterocele ectopia and associated reflux on the outcome of duplex system ureteroceles (DSU) after neonatal transurethral incision (TUI). PATIENTS AND METHODS The study included 41 neonates with a diagnosis of DSU; the ureterocele was ectopic in 24 (58%). Before TUI, vesico-ureteric reflux (VUR) was present in 13 lower moieties (32%) and seven contralateral ureters (17%). TUI was always performed within the first month of life. The follow-up and management were tailored for each patient from the findings at ultrasonography, voiding cysto-urethrography and renal scintigraphy. Results of intravesical and ectopic DSU were compared using Fisher's exact test. RESULTS TUI was effective in allowing ureteric decompression in all but one patient (2.4%). After TUI, VUR ceased in six lower ipsilateral moieties and in two contralateral ureters, while new VUR occurred in three contralateral kidneys. De novo VUR in the punctured moiety appeared in 13 cases (32%). Nine upper poles were not functioning. Twenty-one patients (51%) required secondary surgery. Ureteric reimplantation was indicated exclusively for reflux in the punctured moiety in only in two cases (5%), while in a further two iatrogenic reflux in a nonfunctioning upper moiety required total heminephro-ureterectomy. There was no significant difference between intravesical and ectopic ureteroceles in the occurrence of VUR in the punctured moiety, rate of nonfunctioning upper poles or need for secondary surgery. CONCLUSIONS About half of the patients with a DSU need secondary surgery, but this is rarely indicated for de novo reflux in the punctured moiety only. The need for secondary surgery was greater whenever there was associated reflux before endoscopic incision. There was no difference in the outcome of intravesical and ectopic ureteroceles and such distinction seems no longer to be of clinical relevance.
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Affiliation(s)
- M Castagnetti
- E. Albanese Hospital, Paediatric Surgery Unit, University of Palermo, Palermo, Italy.
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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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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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Holmes NM, Coplen DE, Strand W, Husmann D, Baskin LS. Is Bladder Dysfunction and Incontinence Associated with Ureteroceles Congenital or Acquired? J Urol 2002. [DOI: 10.1016/s0022-5347(05)64732-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nicholas M. Holmes
- From the Department of Urology and Pediatrics, University of California-San Francisco, San Francisco, California, and Departments of Urology, Washington University, St. Louis Children’s Hospital, St. Louis, Missouri, University of Texas Southwestern and Children’s Medical Center, Dallas, Texas, and Mayo Clinic, Rochester, Minnesota
| | - Douglas E. Coplen
- From the Department of Urology and Pediatrics, University of California-San Francisco, San Francisco, California, and Departments of Urology, Washington University, St. Louis Children’s Hospital, St. Louis, Missouri, University of Texas Southwestern and Children’s Medical Center, Dallas, Texas, and Mayo Clinic, Rochester, Minnesota
| | - William Strand
- From the Department of Urology and Pediatrics, University of California-San Francisco, San Francisco, California, and Departments of Urology, Washington University, St. Louis Children’s Hospital, St. Louis, Missouri, University of Texas Southwestern and Children’s Medical Center, Dallas, Texas, and Mayo Clinic, Rochester, Minnesota
| | - Douglas Husmann
- From the Department of Urology and Pediatrics, University of California-San Francisco, San Francisco, California, and Departments of Urology, Washington University, St. Louis Children’s Hospital, St. Louis, Missouri, University of Texas Southwestern and Children’s Medical Center, Dallas, Texas, and Mayo Clinic, Rochester, Minnesota
| | - Laurence S. Baskin
- From the Department of Urology and Pediatrics, University of California-San Francisco, San Francisco, California, and Departments of Urology, Washington University, St. Louis Children’s Hospital, St. Louis, Missouri, University of Texas Southwestern and Children’s Medical Center, Dallas, Texas, and Mayo Clinic, Rochester, Minnesota
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Gomes J, Mendes M, Castro R, Reis A. Current role of simplified upper tract approach in the surgical treatment of ectopic ureteroceles: a single centre's experience. Eur Urol 2002; 41:323-7. [PMID: 12180236 DOI: 10.1016/s0302-2838(02)00042-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Despite renewed interest in either endoscopic decompression or complete reconstruction as primary approaches in ectopic ureterocele's (EU's) treatment, we advocate that a simplified upper tract approach is an optimal choice in a large subset of these patients. We review our surgical results to evaluate the effectiveness of different surgical procedures used in the treatment of EU, based on an individualized approach. PATIENTS AND METHODS We retrospectively analysed all patients with EU and without previous treatment (n = 59) operated in this centre between the years 1991 and 2000. This disorder was bilateral in three patients (62 EU) and associated with duplex ureters in 60 cases. Vesicoureteral reflux (VUR) was diagnosed pre-operatively in 49.1% of patients. Treatment and choice of procedure was based on patients' age, clinical manifestations, associated abnormalities and function of the ureterocele-bearing moiety. Patients were divided in three separate groups according to the initial surgical approach. Group 1-11 patients submitted to endoscopic puncture (six urgent ureterocele decompression, four infants with obstruction of a functional ureterocele-bearing moiety and another with both lower pole ureter and mild bladder outflow obstruction). Group 2-30 patients (31 EU) submitted to a simplified upper tract approach--pyeloureterostomy (1), heminephrectomy (29) and nephrectomy (1) (all patients but one with non-viable renal segments; VUR, grade < or = III, present in six cases). Group 3-18 patients (20 EU) submitted to complete primary reconstruction (all patients with high-grade and/or contralateral reflux, with or without function of the ureterocele-bearing moiety). Success (clinically asymptomatic patients, without obstruction or VUR) and complication rates from the different approaches were analysed. For statistical evaluation, we used Fisher's exact test with p < or = 0.05 considered significant. RESULTS The success rate of endoscopic treatment, simplified upper tract approach and complete reconstruction were 18.2%, 80% and 83.3%, respectively. Major complications occurred in two patients from group 3. CONCLUSION Endoscopic puncture is our first option when immediate ureterocele decompression is required, although it seldom affords definitive treatment. Complete primary reconstruction is necessary in complex cases. Cure rates are high but there is a potential risk for serious complications. A simplified upper tract approach is curative in most patients without associated reflux. Heminephrectomy remains our first choice in a large subset of patients with non-viable or hypofunctional renal segments and without high-grade reflux.
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Affiliation(s)
- J Gomes
- Department of Urology, St. João Central Hospital, Alameda Prof. Hernâni Monteiro, 4200 Porto, Portugal.
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Somoza Argibay I, Méndez Gallart R, Gómez Tellado M, Pais Piñeiro E, Liras Muñoz J, Vázquez Martull E, Vela Nieto D. [Treatment of pyeloureteral duplication associated with ureterocele or ectopic ureter]. Actas Urol Esp 2001; 25:731-6. [PMID: 11803780 DOI: 10.1016/s0210-4806(01)72709-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pyeloureteral duplication is often associated to ureterocele and ectopic ureter. Therapeutic approach of ureterocele is actually a debated subject because of the differences treatments. There is controversy about the classic heminefrectomy with ureterocele aspiration and the minimal invasive endoscopic approach. MATERIAL AND METHODS We made a retrospective study about 34 children with pyeloureteral duplication associated with ureterocele (26) or with ectopic ureter (8). The election of treatment was mainly based on renal function, showed on gammagraphy. It was performed heminephrectomy and ureterocele aspiration in patients with hypofunctioning upperpole, and surgery saving the kidney when the renal function was normal. RESULTS Heminephrectomy was curative in 66.5% of children with ureterocele. In the others was required a correction of the vesicoureteral reflux associated with the lower pole or removal of the ureterocele with ureteral reimplantation due to failure in ureterocele collapse. 88.5% of ureterocele was collapsed. None of the heminefrectomies performed on patients with ectopic ureter needed further surgery. Pathology studies showed a high incidence of renal dysplasia (63%). CONCLUSION We consider the heminephrectomy the treatment of choice in pyeloureteral duplication associated with ureterocele and ectopic ureter when gammagraphy studies show hypofunctioning upperpole.
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Affiliation(s)
- I Somoza Argibay
- Servicio de Cirugía Pediátrica, Hospital Materno Infantil Teresa Herrera, Complejo Hospitalario Juan Canalejo, A Coruña
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