Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System

Adorisio, Ottavio; Elia, Antonio; Landi, L.; Taverna, Maria; Malvasio, Valeria; Danti, Alfredo

doi:10.1016/j.urology.2010.02.061

Cited by 54 publications

(47 citation statements)

References 22 publications

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“…15 Again, there is no consensus on how to manage these cases, and there are other factors to take into account, such as the age of the patient and parental preference. Also, it has been reported that VUR may subside spontaneously 3,14 and, in some series, VUR status did not have any role in guiding the selection of the first procedure. 10 In spite of the evidence supporting all of these facts regarding the surgical management of duplication anomalies, it is important to note that this is still a very controversial issue.…”

Section: Discussionmentioning

confidence: 96%

“…4 However, since this relationship with the appearance of malignancies was never proven, 12 and since this surgery can give rise to complications such as damage to the remaining moiety, more conservative approaches have been gaining support for patients without UTIs, at times even when VUR is present. 4,13,14 Group B, in which ureterocele was absent, was more heterogeneous. The manifestations and remaining renal function depended on the coexisting findings (such as VUR and an ectopic ureter, present in a significant percentage of the patients in this group), which ultimately defined the chosen procedure.…”

Section: Discussionmentioning

confidence: 99%

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Complete Ureteral Duplication: Outcome of Different Surgical Approaches

2016

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(12); reimplantação de ureter (3); pielopielostomia (2) e heminefrectomia (1). Foi necessário reintervir em três dos 12 casos submetidos a punção: heminefrectomia (1), ureteroureterostomia (1) e reimplantação (1). No grupo B (n = 23), foi efetuado STING em 10 unidades, reimplantação ureteral em três, pielopielostomia em três, ureteroureterostomia em um, e heminefrectomia em seis; dois casos necessitaram de reintervenção. Discussão: Foi favorecida uma abordagem primária conservadora para tratamento de ureterocelo ou refluxo em hemissistemas a preservar (53,7%; n = 22/41), tendo sido eficaz per se em 75% (n = 9/12) unidades do grupo A e 80% (n = 8/10) do grupo B. Uma abordagem ablativa primária foi adotada em 17% (n = 7/14) casos, 5,6% do grupo A (n = 1/18) e 26,1% do grupo B (n = 6/23). Conclusão: Uma abordagem conservadora é eficaz como procedimento primário isolado na maioria dos casos com ureterocelo ou refluxo. Mais estudos são necessários para estabelecer as suas vantagens sobre abordagens primárias invasivas ou ablativas. Palavras-chave: Nefrectomia; Refluxo Vesicoureteral; Ureter/anomalias; Ureter/cirurgia. ABSTRACT Introduction:The surgical management of complete ureteral duplication anomalies is not consensual. Objective: To characterize the pediatric population who underwent surgery for complete ureteral duplication and assess the outcomes of different approaches. Material and Methods:Clinical records from patients treated between January 2008 and June 2014 were retrospectively reviewed. Epidemiology, diagnosis, clinical manifestations and surgical procedures were collected and analysed. Ureteral units were divided into two groups: A, with ureterocele; and B, without it. Results: Forty-one ureteral units from 32 patients with complete duplication underwent surgery. In group A (n = 18), the selected primary procedure was: ureterocele punction (12); ureter reimplantation (3); pyelopyelostomy (2); heminephrectomy (1). A reintervention was required in 3 of the 12 units submitted to punction: heminephrectomy (1), ureteroureterostomy (1), and ureteric reimplantation (1). In group B (n = 23), STING was performed in 10 units, ureteric reimplantation in 3, pyelopyelostomy in 3, ureteroureterostomy in 1, and heminephrectomy in 6; two cases required reintervention. Discussion: A conservative primary approach was favoured in cases with ureterocele and/or reflux in hemisystems worth preserving (53.7%); it was effective per se in 75% (n = 9/12) units in group A and 80% (n = 8/10) in group B. An ablative primary procedure was adopted in 17% (n = 7/41) cases, 5.6% of group A (n = 1/18) and 26.1% of group B (n = 6/23). Conclusions:A conservative approach is effective as a primary and isolated procedure in the majority of cases with ureterocele or vesicoureteral reflux. Further studies are needed to establish the advantages over primary invasive or ablative approaches.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Complete Ureteral Duplication: Outcome of Different Surgical Approaches

2016

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“…El tratamiento inicial de un ureterocele prolapsado consiste en la descompresión de la masa mediante punción endoscópica o nefrostomía. 13 La reducción manual de la masa es posible, pero la recurrencia es frecuente. Cuando la descompresión es eficaz, no hay RVU ni obstrucción y la función renal es normal, se puede seguir al paciente de forma conservadora, sin necesidad de una nueva cirugía.…”

Section: Figura 1 Imagen Redondeada Y De Aspecto Quístico De Localizunclassified

Ureterocele prolapsado: un diagnóstico para tener en cuenta ante una masa vulvar en una lactante. A propósito de un caso

Fernández

Madrid

2017

Arch Argent Pediat

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Presentación de casos clínicos RESUMENEl ureterocele es una malformación del sistema urinario relativamente frecuente en niños; sin embargo, el prolapso del ureterocele a través de la uretra es una presentación, en extremo rara. La urorresonancia magnética es la prueba de elección para el diagnóstico definitivo. El tratamiento inicial de un ureterocele prolapsado consiste en la descompresión de la masa. Presentamos el caso clínico de una lactante de 7 meses con duplicación del sistema colector y ureterocele ectópico derecho, que apareció como una masa vulvar. Palabras clave: ureterocele, pediatría, prolapso, masa vulvar. ABSTRACTUreterocele is a relatively common malformation of the urinary system in children; however, the ureterocele prolapse through the urethra is an extremely rare presentation. Urological nuclear magnetic resonance is the test of choice for definitive diagnosis. Initial treatment of a prolapsed ureterocele involves decompression of the mass. We report the case of a 7-month-old infant with duplication of the collecting system and right ectopic ureterocele appearing as a vulvar mass.

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“…Allerdings trägt dieses Vorgehen das Risiko eines späteren VUR in die Einheit. Adorisio et al [14] zeigen in Ihrer 2010 publizierten Arbeit, dass nur 30% der Kinder mit Ureterozele und Doppelsystem einen VUR entwickeln, wovon zwei Drittel spontan maturieren. Ein Großteil der intravesikalen Ureterozelen können mittels endoskopischer Inzision ohne Notwendigkeit einer sekundären Operation dekomprimiert werden.…”

Section: Ureterduplikaturen Ureterektopien Und Ureterozelenunclassified

Harntransportstörungen (Hydronephrosen)

Rogenhofer

Müller

2011

Urologe

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The prevalence of malformations of the kidneys is quite high compared to other congenital malformations. In a study of the Association for Neonatology of Mecklenburg-West Pomerania examining 37,634 births, a hydronephrotic kidney was diagnosed in 16.7 of 10,000 children. Depending on the type and severity of the congenital malformation it might be difficult to find out when there is a risk for loss of renal function. Unfortunately, in 2010 health politicians (the Gemeinsame Bundesausschuss) voted against routine ultrasound screening for renal abnormalities in newborns despite an increasing number of pre- or postnatally diagnosed dilated kidneys in recent years. Will this lead to a decrease in the diagnosis of hydronephrosis with possible loss of renal function later on? According to Roth et al. the incidence of in utero dilatations of the urinary tract is about 1:100, but only 1:500 children have a clinically relevant problem. This raises the question of which of these young patients need an intervention and which might be monitored expectantly.

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Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System

Cited by 54 publications

References 22 publications

Complete Ureteral Duplication: Outcome of Different Surgical Approaches

Complete Ureteral Duplication: Outcome of Different Surgical Approaches

Ureterocele prolapsado: un diagnóstico para tener en cuenta ante una masa vulvar en una lactante. A propósito de un caso

Harntransportstörungen (Hydronephrosen)

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