Long-term outcome based on the initial surgical approach to ureterocele

Purpose: The management of extravesical ureterocele is controversial. Hemin ephrectomy and recently recommended primary incision or puncture have high reoperation rates. We reviewed and compared the long-term results of these procedures with those of primary lower tract reconstruction for ureterocele . Materials and Methods: We reviewed the records of 106 children with uretero cele treated between 1979 and 1997. Followup was available in 99 patients, including 72 with extravesical and 27 with intravesical ureterocele. Patien ts with extravesical ureterocele were divided based on initial management i nto group 1-13 who underwent transurethral incision or puncture, group 2-41 who underwent an upper tract approach, including partial or complete nephr ectomy with partial ureterectomy or ureteroureterostomy and group 3-18 who underwent complete reconstruction, including ureterocelectomy and ureteral reconstruction with or without upper tract surgery. Results: Overall the reoperation rate in patients with intravesical uretero cele was 22% and 23% in those treated with initial endoscopic incision or p uncture. In patients with extravesical ureterocele the reoperation rate was 100, 41 and 0% in groups 1 to 3, respectively. Differences in followup (ov erall mean 6 years) and the incidence of preoperative reflux in the 3 group s were not statistically significant. In group 2, the reoperation rate in p atients with versus without preoperative reflux was 57 versus 20% (p = 0.08 ). Of the 25 prenatally diagnosed patients urinary tract infection develope d preoperatively in 3 (12%) at ages 2, 3, and 6 months, respectively. Mean age at the time of the initial operation in all prenatally diagnosed patien ts was 3.1 months (range 5 days to 11 months). Conclusions: Complete reconstruction appears to be safe and highly effectiv e even in infancy for treating extravesical ureterocele. Although the prima ry upper tract approach is associated with a significantly higher reoperati on rate, it is a favorable alternative in patients with no preoperative ref lux. However, while transurethral decompression is effective in the majorit y of patients with intravesical ureterocele, it is not definitive therapy f or extravesical ureterocele and it should have a limited role in initial ma nagement.