Does the Endoscopic Technique of Ureterocele Incision Matter?

Meir, David Ben; Silva, C.J.T.D.A.E.; Rao, P. N.; Chiang, David T.; Dewan, PA

doi:10.1097/01.ju.0000129228.92805.31

Cited by 25 publications

(17 citation statements)

References 17 publications

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“…Endoscopic decompression of the ureterocelic sac and of upper tract dilatation included several modalities, that have been offered along the last two decades: unroofing, incision, and punctures are different methods proposed and adopted to decompress the UTC (20–22). The energy source used for decompression includes Collins knife, diathermic electrocautery, and more recently holmium laser (14, 22).…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Laser Treatment of Ureterocele

Caione¹,

Nappo²,

Collura³

et al. 2019

Front. Pediatr.

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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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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Laser Treatment of Ureterocele

Caione¹,

Nappo²,

Collura³

et al. 2019

Front. Pediatr.

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“…We think that technical factors may interfere in the outcomes of TUI in DSU. It has been reported that the choice of TUI approach is important for achieving efficient decompression without causing VUR [23] , [24] . Whatever the approach, it is recommended that the TUI should be performed above the level of the bladder wall in the intravesical portion of the ureterocoele to create a valve-like flap, thus avoiding VUR [15] , [19] , [22] .…”

Section: Discussionmentioning

confidence: 99%

Is transurethral incision better than upper pole partial nephrectomy for management of duplex system ureterocoele diagnosed in the first year of life?

Hodhod

Noureldin

El‐Sherbiny

2017

Arab Journal of Urology

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ObjectiveTo compare the outcomes of transurethral incision (TUI) and upper pole partial nephrectomy (PN) in patients with duplex system ureterocoele (DSU).Patients and methodsWe 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.ResultsBetween 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.ConclusionThis study shows significant renal function preservation with TUI compared to PN. However, secondary surgical interventions were higher with TUI.

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“…Regarding the occurrence of de novo reflux and the decompression rate of the upper urinary system, there is no significant difference among the methods of endoscopic ablation (Table 3). 50–55 Further randomized controlled studies are necessary for such an alternative approach.…”

Section: Introductionmentioning

confidence: 99%

Recent trends of genitourinary endoscopy in children

Nonomura

Κakizaki

2005

Int J of Urology

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Downsizing and refinement of the pediatric endoscope in video-monitoring systems have facilitated genitourinary endoscopy even in small children without any traumatic instrumentation. Indications for endoscopy in children with hematuria or tractable urinary tract infection have been tailored for the rareness of genitourinary malignancy or secondary vesicoureteral reflux (VUR) as a result of infravesical obstruction. Most mechanical outlet obstructions can be relieved endoscopically irrespective of sex and age. Endoscopic decompression by puncture or incision of both intravesical and ectopic ureteroceles can be an initial treatment similar to open surgery for an affected upper moiety. Endoscopy is necessary following urodynamic study to exclude minor infravesical obstruction only in children with unexplained dysfunctional voiding. Genitourinary endoscopy is helpful for structural abnormalities before and at the time of repairing congenital urogenital anomalies. Endoscopic injection therapy of VUR has been established as a less invasive surgical treatment. Pediatric endoscopy will play a greater role in the armamentarium for most pediatric urological diseases through the analysis of visual data and discussion on the indications for endoscopy throughout the world.

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Does the Endoscopic Technique of Ureterocele Incision Matter?

Cited by 25 publications

References 17 publications

Minimally Invasive Laser Treatment of Ureterocele

Minimally Invasive Laser Treatment of Ureterocele

Is transurethral incision better than upper pole partial nephrectomy for management of duplex system ureterocoele diagnosed in the first year of life?

Recent trends of genitourinary endoscopy in children

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