THE VALUE OF ENDOSCOPIC TREATMENT FOR URETEROCELES DURING THE NEONATAL-PERIOD

Purpose: We report a series of 35 neonates presenting with ureterocele diagnosed during the antenatal period or during the first weeks of li fe. The first line treatment was an endoscopic incision. Materials and Methods: Immediate postnatal evaluations detected 37 ureteroceles (bi lateral in 2 cases), including 16 of the intravesical type and 21 that were ectopic. Endoscopic incision permitted decompression of the majo rity of ureteroceles and improvement in renal function in most cases. Secondary low grade vesicoureteral reflux appeared in 9 neonates (ecto pic in 8 cases) and had already been present in 14 patients. Results: Endoscopic treatment alone proved effective in 14 of the intravesical ureteroceles, while the other 2 cases requiring upper pole nephrectomy (1) and ureterovesical reimplantation using the Cohen technique (1). In contrast, among patients with the ectopic form additional surgery w as necessary in 18 cases. Treatment comprised resection of the uretero cele with bladder reconstruction and ureteral reimplantation without r emodeling according to the Cohen technique in 15 cases, total ureteron ephrectomy in 1 and pole nephrectomy in 2. Conclusions: We suggest tha t early endoscopic incision be used for first line treatment of ureter oceles. The aim of this procedure is to ensure better urine drainage, preserve function of the parenchyma and reduce the risk of severe infe ction in the neonate. The principal complication remains secondary ves icoureteral reflux onset, which can be controlled well by antibiotic p rophylaxis but requires regular radiological monitoring.