TRANSURETHRAL PUNCTURE OF ECTOPIC URETEROCELES IN NEONATES AND INFANTS

Ten neonates and infants with 11 ectopic ureteroceles prospectively un derwent transurethral puncture as the primary form of therapy. Of the 10 patients 6 had a prenatal diagnosis of uropathy and 4 presented pos tnatally with urinary tract infection. One patient had bilateral singl e system ectopic ureteroceles and 9 had a single ectopic ureterocele i n a duplex system. Significant associated ipsilateral and/or contralat eral urological pathology was noted in addition to the ectopic uretero cele in 7 patients. Transurethral puncture adequately decompressed 10 of the 11 ectopic ureteroceles (91%) and improved drainage of nonurete rocele moieties in 3 cases. Iatrogenic reflux was found in 3 of the 11 ureterocele ureters. Urinary tract infection developed in 6 infants ( 4 with fever). Of the 10 patients 8 (80%) eventually required secondar y surgical intervention because of recurrent urinary tract infections, persistent or iatrogenic reflux, or unresolving hydronephrosis. Altho ugh transurethral puncture rarely constitutes definitive treatment for ectopic ureterocele, there appears to be immediate benefit in cases o f bilateral hydronephrosis or significant ipsilateral lower pole hydro nephrosis. Decompression of the ureterocele is reliably obtained but i t seldom obviates the need for more definitive reconstruction.