Does the endoscopic incision of ureteroceles reduce the indications for partial nephrectomy?

Objective To determine whether the endoscopic incision of ureteroceles redu ces the indications for partial nephrectomy. Patients and methods Between 1987 and 1996, endoscopic incision was used as the first-line treatment of 18 children (13 boys, five girls, aged 8 days to 6 months) with a duplex-system ureterocele diagnosed antenatally (15) or in the first weeks of life during the course of a urinary infection (three ). Of the 19 ureteroceles (one bilateral), four were intravesical and 15 ec topic, according to the American Academy of Paediatrics classification. Ves ico-ureteric reflux into the inferior pole of the kidney was present in 10 children, seven of whom had an ectopic ureterocele. A functioning upper por e was detected by intravenous pyelography (IVP) in half the intravesical an d in a third of the ectopic ureteroceles. Results Endoscopic incision resulted in decompression and reduction of dila tation in 16 cases; three with inferior pole reflux resolved on control cys tography, whilst in seven with an ectopic ureterocele, reflux into the uppe r urinary tract was induced by endoscopic incision. In three children with an ectopic ureterocele, renal function had improved at 3 months, as assesse d by IVP. Endoscopic incision was the only treatment for half the intravesi cal and six of 15 ectopic ureteroceles. Overall, nephrectomy was required i n four of 18 patients (three partial nephrectomies for persistent dilatatio n and one total nephrectomy). Five nonfunctioning, undilated upper poles wi th no reflux were left in place. Nine vesico-ureteric reimplantations for p ersistent or induced reflux were carried out using the Cohen technique. Conclusion Endoscopic incision can allow the deferral of nephrectomy, facil itate lower urinary tract reconstruction and reduce the indications for par tial nephrectomy, if it is accepted that a nonfunctioning, undilated renal pole with no reflux can safely be left in place.