URETEROCELES IN CHILDREN - AN ONGOING CHALLENGE

The treatment of ureteroceles in children requires an individualised a pproach. Antenatal diagnosis is the ideal, so that postnatal urinary a ntibiotic prophylaxis and appropriate investigations can be organised. Postnatal investigations should assess both upper and lower urinary t ract. Renal and bladder ultrasound and radiographic micturating cystou rethragraphy under antibiotic cover will both detect vesicoureteric re flux and assess any bladder outlet obstruction due to the ureterocele. Renal function, particularly of the upper moiety, is best evaluated b y technetium Tc-99m dimercaptosuccinic acid renal scan. Both function and obstruction can be quantitated by the Tc-99m-mercaptoacetyltriglyc ine isotope scan with intravenous volume expansion (10 ml/kg) and furo semide diuresis (1 mg/kg). Intravenous urography provides the best ana tomic information when the upper moiety is functional. The surgical ma nagement is based on the clinical situation, which is often variable, and therefore needs to be tailored for each patient. The general princ iples include restoration of anatomy to as near normal as possible and preservation of functional renal tissue.