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Oueslati A, Saadi A, Chakroun M, Zaghbib S, Bouzouita A, Derouiche A, Slama MRB, Ayed H, Chebil M. Endoscopic meatotomy in the treatment of ureterocele: results in adult patients. Pan Afr Med J 2020; 36:243. [PMID: 33014239 PMCID: PMC7519792 DOI: 10.11604/pamj.2020.36.243.24941] [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: 07/11/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a “smiling mouth” meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate.
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Affiliation(s)
- Amine Oueslati
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ahmed Saadi
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Selim Zaghbib
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Amine Derouiche
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Haroun Ayed
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Chebil
- Urology Department, Charles Nicolle Hospital, Tunis, Tunisia
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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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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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Seth JH, Walker R. Case of acute severe postpartum urinary incontinence: an extravesical subsphincteric prolapsed ureterocoele. BMJ Case Rep 2018; 2018:bcr-2017-220290. [PMID: 29330267 DOI: 10.1136/bcr-2017-220290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 32-year-old woman presents to outpatients 10 days postpartum, with symptoms of an intermittent vaginal lump and urinary incontinence. Vaginal examination revealed no demonstrable prolapse or stress incontinence. A swelling in the bladder was noted during an antenatal scan suggesting a ureterocoele. She was referred for pelvic floor physiotherapy in the first instance. Forty-eight hours later, she represented to casualty with discomforting vaginal lump symptoms and continuous urinary incontinence. At this stage on vaginal inspection, there was an evident dusky lump emerging from the urethra with continuous incontinence. An extravesical subsphincteric prolapsed ureterocoele was evident, 5 cm beyond the external urethral meatus. The diagnosis was confirmed with an MRI scan which demonstrated the prolapsed obstructing ureterocoele causing significant left-sided hydroureteronephrosis. The ureterocoele was managed with a cystoscopy and transurethral incision of the ureterocoele under anaesthesia, which facilitated drainage and resolution. At 3-month postoperatively, the patient remains continent and satisfied.
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Affiliation(s)
- Jai H Seth
- Department of Urology, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, UK
| | - Roger Walker
- Department of Urology, Epsom and Saint Helier University Hospitals NHS Trust, Carshalton, UK
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Liu C, Chen W, Xie C, Guan W, Zhao Y, Ouyang Y, Xu Y, Wu Y, Wang X, Wang Y, Zhang X. Efficacy and Safety of Transurethral Photoselective Greenlight(™) Laser Vaporization for the Treatment of Orthotopic Ureteroceles in Adults. Photomed Laser Surg 2015; 33:326-9. [PMID: 26067941 DOI: 10.1089/pho.2015.3889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study aimed to retrospectively evaluate the safety and efficacy of transurethral photoselective Greenlight(™) laser vaporization in adult patients with orthotopic ureterocele. MATERIALS AND METHODS Thirty adult patients diagnosed with orthotopic urecterocele were recruited at our center. Transurethral photoselective Greenlight laser vaporization was used as the exclusive technique for endoscopic management during the study period. Information, including age, gender, mode of presentation, ureterocele size, vesicoureteral reflux, hydronephrosis status, and incidence of reoperation, were collected for evaluation. RESULTS Our series included 12 men and 18 women. The mean patient age at presentation was 30.5 years (range, 18-62 years). The mean size of ureterocele was 18 mm (range, 10-41 mm). All patients successfully underwent transurethral photoselective Greenlight laser to vaporize the ureterocele. The operation ranged from 13 min to 38 min (mean 19.6 min). The average blood loss was <10 mL. No patient had intraoperative complications. The average postoperative hospital stay was 18.3 h. All patients were voided after postoperative catheter removal. None of the patients demonstrated any residual ureterocele and/or hydronephrosis when evaluated with ultrasonography after 3 months. Only one patient with a duplex collecting system presented asymptomatic low-grade reflux at 3 months, which was spontaneously resolved after 6 months of follow-up. All patients were free of any symptoms. No reoperative procedures were required at a mean follow-up of 14.2 months (range, 8-16). CONCLUSIONS Transurethral photoselective Greenlight laser vaporization is safe, effective, and efficient for the management of orthotopic urecteroceles in adults. Therefore, this technique should be considered as the initial treatment in most patients.
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Affiliation(s)
- Cuilong Liu
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Weihao Chen
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Changliang Xie
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Weimin Guan
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Yubo Zhao
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Yun Ouyang
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Yansheng Xu
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Yiguang Wu
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Xiyou Wang
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Yi Wang
- Department of Urology, General Hospital of the Navy , Beijing, China
| | - Xinyu Zhang
- Department of Urology, General Hospital of the Navy , Beijing, China
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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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Isen K. Technique using a percutaneous nephroscope and nephroscopic scissors transurethrally for treatment of complicated orthotopic ureterocele in adult women. Urology 2012; 79:713-6. [PMID: 22386426 DOI: 10.1016/j.urology.2011.11.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/09/2011] [Accepted: 11/29/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present an endoscopic technique for the decompression of complicated orthotopic ureterocele in adult women. METHODS Five women with complicated orthotopic ureterocele were evaluated in the present study. The ureterocele was complicated by stones in 2 patients and urinary tract infection in 4. An endoscopic technique was used for the treatment of these ureteroceles. A 26F rigid nephroscope was placed into the bladder. When the ureterocele was seen in the bladder, the nephroscopic scissors was advanced through the nephroscopic channel to the ureterocele. A puncture was made on the anterior wall of the ureterocele using the nephroscopic scissors. Next, a ureteral catheter was introduced to puncture the ureterocele. Next, a window approximately 5-10 mm in diameter was opened on the wall of the ureterocele using the nephroscopic scissors. Finally, a double-J stent and urethral catheter were placed. The stones were fragmented using a pneumatic lithotripter. All the patients were evaluated with urinalysis, urine culture, ultrasonography, and voiding cystourethrography at the third month postoperatively. RESULTS The mean procedure time was 18.4 minutes. No complication was observed during the procedure, except for mild hematuria. The mean postoperative hospital stay was 19.8 hours. All patients with stones were stone free after the procedure. No cases of postoperative urinary tract infection developed. None of these patients had de novo reflux or obstruction at 3 months postoperatively. CONCLUSION This technique could be an alternative treatment option for decompression of complicated orthotopic ureterocele in adult women.
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Affiliation(s)
- Kenan Isen
- Clinic of Urology, Ministry of Health, Diyarbakir Education and Research Hospital, Diyarbakir, Turkey.
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Shah HN, Sodha H, Khandkar AA, Kharodawala S, Hegde SS, Bansal M. Endoscopic management of adult orthotopic ureterocele and associated calculi with holmium laser: experience with 16 patients over 4 years and review of literature. J Endourol 2008; 22:489-96. [PMID: 18271717 DOI: 10.1089/end.2007.0312] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and effectiveness of holmium laser endoscopic incision and laser lithotripsy in adults with orthotopic ureterocele and associated calculi. PATIENTS AND METHODS From May 2003 to August 2007 at our center, 16 adults underwent transurethral incision of an ureterocele and intracorporeal holmium laser lithotripsy for associated calculi. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition. RESULTS Ureterocele was associated with a single system in 13 patients. Two patients had bilateral ureteroceles. Four patients had associated upper tract stones. The procedure was uneventful in all patients. The average postoperative hospital stay was 19.3 hours. All patients were stone free after the procedure. Eleven patients were available for follow-up at 3 and 6 months. None of these patients had any evidence of residual ureterocele and/or hydronephrosis when evaluated with intravenous urography at 3 months. Micturating cystourethrography (MCU) at 3 months revealed low-grade vesicoureteral reflux (VUR) in four patients; no reflux was found with MCU at 6 months. CONCLUSIONS Laser endoscopic management of adult orthotopic ureterocele and associated calculi effectively decompressed ureterocele and removed stones in all patients without any significant postoperative morbidity. Low-grade VUR that may occur postoperatively resolved at 6 months. A literature review suggests that the ability of the holmium laser to manage both ureterocele and calculi simultaneously should make holmium laser management a procedure of choice at centers that possess the equipment.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India.
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Singh I. Adult bilateral non-obstructing orthotopic ureteroceles with multiple calculi: endoscopic management with review of literature. Int Urol Nephrol 2007; 39:71-4. [PMID: 17268900 DOI: 10.1007/s11255-006-0091-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 03/30/2006] [Indexed: 10/23/2022]
Abstract
We describe and report two cases of bilateral symptomatic ureterocele with calculi in two young adult women. They were successfully managed endoscopically by a transverse meatotomy and stone extraction done bilaterally in a single operative session. The 6th month postoperative voiding cystourethrogram showed no reflux. The literature regarding the incidence, occurrence, diagnosis and management of this uncommon condition in adults has been reviewed and discussed.
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Affiliation(s)
- Iqbal Singh
- Department of Surgery, University College of Medical Sciences (University of Delhi) and GTB Hospital, F-14 South Extension Part-2, New Delhi 110049, India.
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