Can a Single Individualized Procedure Predictably Resolve All the Problematic Aspects of the Pediatric Ureterocele?

Abstract

A single procedure that definitively treats all problems of a ureterocele can be selected in more than three-quarters of patients. Transurethral incision was unsuccessful at definitively treating these patients in our experience. An isolated upper tract procedure was successful in patients with no or mild associated vesicoureteral reflux. We think that upper tract surgery should be the procedure of choice in this subset of patients, as it usually resolves the problem and does not subject the patient to the potential morbidities of bladder surgery. Although total reconstruction is a more formidable procedure, it can be performed safely with excellent results.

Factors Associated with Complications of the Ureteral Stump After Proximal Ureteroureterostomy

“…3,8 As endoscopic procedures are reported to have high recurrence rates in cases of ectopic ureterocele, their use has been limited to intravesical ureteroceles or temporary decompression in ectopic ureteroceles before open surgery. 8,9 Open surgery for the management of EU can be classified into a bladder level approach or an upper tract approach according to the level of the operation. 6,10 Upper tract approaches such as ureteroureterostomy and heminephrectomy have the advantage of not damaging the bladder and, thus, can be performed in young infants before trigonal maturation.…”

Management of duplex system ureteroceles in neonates and infants

“…Introduction the widespread use of ultrasonography has changed the diagnostic pattern of ureteroceles ( Figure 1) such that up to 75% of cases are currently diagnosed antenatally or in early infancy; [1][2][3][4] in the vast majority of cases, the uretero cele affects the upper moiety of a duplex system. 1,2,5 initial management of duplex system ureteroceles (Dsus) in neonates and infants should aim to decrease the risk of urinary tract infections (utis), preserve the function of the lower moiety and contralateral kidney, and avoid bladder dysfunction and incontinence.…”

“…endoscopic decom pression has become popular as a minimally invasive means of achieving timely ureterocele decompression and preventing utis, while avoiding extensive tri gonal surgery, which risks damaging bladder function in infants; 1,4-7 by contrast, total reconstruction has been recommended as the most effective approach to achieve singlestage cure of Dsus and prevent longterm bladder dys function and incontinence. 2,8 Flexible strategies have also been proposed, with approaches chosen depending on preoperative variables, such as ureterocele position (intravesical versus ectopic), and number of moieties with vesicoureteral reflux (vur) or nonrefluxing hydroureteronephrosis (Hun). [9][10][11] Finally, conservative…”

Complications After Common Sheath Reimplantation in Pediatric Patients With Complicated Duplex System

“…3 Unlike its widespread use in intravesical ureterocele, the use of transurethral incision of ureterocele (TUI) has been limited to temporary decompression before open surgery in EU. 4 Open surgery for EU combined with ureteral duplication involves either an upper tract approach (UTA) or a bladder-level approach (BLA). 5,6 The UTA is an effective treatment modality, which does not damage the bladder.…”

“…Only a few reports have been published on BLA in EU, 4,9e11 and most of these focused on TR. 4,9 Herein, we report our experience with CSR in treatment of EU, describing success rates and postoperative complications, along with risk factors for developing postoperative incontinence.…”