Experience with transurethral incision of ureteroceles

Objectives: The value of primary transurethral ureterocele incision was inv estigated in the treatment of ureteroceles in infants and children. Methods : The charts and radiographic studies of 13 patients between the ages of 2 weeks and 8 years who underwent transurethral incision of 14 ureteroceles a s primary surgical therapy at our institution were reviewed. Results: 57% o f the ureteroceles were intravesical and 43% extravesical. 64.3% were assoc iated with the upper pole of a duplicated system. All 14 ureteroceles were associated with a functional renal moiety. Endoscopic incision achieved ure terocele decompression in 13 of 14 ureteroceles (93%). Preexisting hydronep hrosis improved or resolved in 10 of 14 cases (71.4%). Renal function after decompression was not shown to be significantly altered or improved. 5 of 13 patients (38%) required definite surgical reconstruction for recurrent u rinary tract infections, upper pole vesicoureteral reflux, hydronephrosis a nd lower pole vesicoureteral reflux within a mean follow-up period of 14 mo nths. Conclusion: Transurethral incision has a limited role in the treatmen t of ureteroceles in children. In many or even most cases it cannot be expe cted to constitute long-term definite treatment for ureteroceles. It is mai nly indicated in patients with urosepsis, prolapsing ureteroceles with func tional bladder neck obstruction or massive reflux into other renal segments , In these settings it reliably achieves decompression and allows effective treatment of infection. The function of the previously obstructed renal se gment can be reevaluated at later point in time to assess whether it should be saved. The delay permits interim growth that is likely to make bladder reconstruction easier.