Management of complicated ureteroceles: Different modalities of treatment and long-term outcome

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.

Chronic renal failure in a patient with bilateral ureterocele

“…Ureterocele is reported to affect one in 4000 individuals. 5 Few cases of ureterocele have been documented in our country with none complicated with renal failure. It is bilateral in 10% of cases with female preponderance.…”

“…Such individuals will require renal replacement therapy for survival. In their case series, Chowdhary et al 5 reported various complications of ureterocele including development of end stage renal failure. In a review of 305 children in a tertiary hospital, Hari et al 7 documented a high proportion of renal failure due to obstructive uropathy.…”

“…If the ureterocele was detected early, endoscopic incision or surgical excision and reimplantation of the ureters may prevent progression to chronic renal failure. 2 , 5 …”

Bilateral complete ureteral duplication with fixed dumbbell stone formation in the ureterocele

“…14 Otherwise, many patients can be managed conservatively. 15,16 Surgery can be performed endoscopically or through the open approach with excision of the ureterocele and upper pole partial nephrectomy or common sheath reimplantation. 17 Considering its success for intravesical ureteroceles, endoscopic intervention has become the initial choice for nearly two decades.…”

Bilateral Single System Orthotopic Ureterocele with Bilateral Multiple Calculi Presented with Retention of Urine - an Urological Emergency

“…The ureterocele is an abnormal cystic dilatation of distal intramural end of the ureter into the bladder [1]. The most common accepted theory for its pathogenesis is the incomplete dissolution of Chwalla's membrane [2].…”