Long-term outcome of transurethral puncture of ectopic ureteroceles: Initial success and late problems

Purpose: We studied the long-term outcome of transurethral puncture of ecto pic ureteroceles specifically associated with duplex systems. Materials and Methods: We retrospectively reviewed the records of patients who underwent transurethral puncture of an ectopic ureterocele. Study exclu sion criteria were orthotopic, bilateral and prolapsing ureteroceles. Results: We identified 19 girls and 2 boys, of whom II presented with prena tal hydronephrosis and 10 presented with urinary tract infection. Mean age at puncture was 5 months (range 0.5 to 60). Preoperatively voiding cystoure thrography revealed no reflux in 7 patients, isolated ipsilatoral lower pol e reflux in 8, and bilateral and/or contralateral reflux in 6. Postoperativ ely studies initially showed no reflux in 8 cases but in 4 of the 8 reflux recurred up to 4 years after puncture. In 10 patients (48%) reflux develope d into the ureterocele and upper pole segment. Repeat puncture was required 1 to 13 months after the initial procedure in 4 patients for persistent or recurrent upper pole hydroureteronephrosis. Subsequent open surgery was re quired in 15 of the 21 cases (71%), including ureterocele excision with ure teral reimplantation in 14. Of the children 10 and 4 underwent open surgery for recurrent urinary tract infection and progressive reflux, respectively , while 1 underwent ureteroureterostomy for progressive upper pole reflux. No patient underwent upper pole nephrectomy. Of the remaining 6 patients 4 have low grade reflux. Conclusions: Transurethral puncture of ectopic ureteroceles provides effect ive short-term correction of upper pole obstruction but it is not definitiv e therapy in the majority of cases. Most children still require open surger y. In patients without reflux after the puncture procedure new onset, recur rent or progressive reflux may later develop with extended followup. Repeat puncture may be required to ensure adequate decompression in a minority of cases, as in the 20% in our series.