URETEROCELE ASSOCIATED WITH URETERAL DUPLICATION AND A NONFUNCTIONINGUPPER POLE SEGMENT - MANAGEMENT BY PARTIAL NEPHROURETERECTOMY ALONE

We reviewed the records of 87 patients with a ureterocele associated w ith duplication and a nonfunctioning upper pole segment. All patients involved in this study were treated by partial nephroureterectomy and observation. Additional surgery to correct vesicoureteral reflux becam e necessary in 54 cases (62%). A careful retrospective chart and radio graphic review identified that the need for additional surgery was dir ectly related to the number of renal moieties that had a ureterocele o r vesicoureteral reflux present. In particular, when a ureterocele alo ne was preent 21 of 21 patients (100%) did not require additional surg ery. When low grade (less than 3/5) reflux was present into 1 ureter 8 of 15 patients (60%) did not require surgery. The presence of high gr ade reflux into 1 moiety or vesicoureteral reflux into more than 1 moi ety, regardless of the grade of reflux, almost inevitably resulted in the need for further surgery with only 2 of 50 patients (4%) with thes e abnormalities cured by partial nephroureterectomy alone. Our data su ggest that this latter group of patients may be treated more efficacio usly by complete genitourinary reconstruction rather than partial neph roureterectomy alone.