The modern endoscopic approach to ureterocele

Purpose: During the last 20 years the surgical approach to ureterocele has evolved from major open surgery to minimally invasive endoscopic puncture. We believe that the endoscopic approach decreases the need for open surgica l procedures. We identified specific factors that predict the need for repe at surgery. Materials and Methods: We reviewed the charts of 60 new patients with urete rocele treated with primary endoscopic incision between 1991 and 1995. Foll owup ranged from 4 to 62 months (mean 20). Mode of presentation, ureterocel e location, associated vesicoureteral reflux and association of the uretero cele with a duplex system were evaluated. Ureterocele wall thickness was as sessed subjectively via radiographic and cystoscopic methods, and categoriz ed as thin, intermediate and thick. Results: All 9 patients with a single system ureterocele had an intravesica l ureterocele. No patient had associated reflux nor did any require a secon dary open procedure. In 3 cases new onset ipsilateral reflux into the urete rocele spontaneously resolved. Of the 51 patients with a duplex system and associated ureterocele 19 (37%) required a secondary open procedure. The ur eterocele was intravesical and ectopic in 22 (43%) and 29 (57%) cases, resp ectively. Reflux was associated with the ureterocele in 27 patients (53%), and 12 (44%) required a secondary open procedure. A total of 11 patients un derwent ureteral reimplantation of 15 refluxing renal units and only 2 rena l units required ureteral tapering. Reflux is no longer present in 14 of th e 15 renal units (93%). Patients with a thick walled ureterocele required r epeat puncture more frequently than those with a nonthick ureterocele. Conclusions: With the use of modern endoscopic techniques children with int ravesical and single system ureteroceles require secondary open surgery les s frequently than those with ectopic and duplex system ureteroceles. The mo de of presentation does not predict the need for a repeat open procedure. T hick walled ureteroceles require repeat endoscopic puncture more frequently than thin and intermediate walled ureteroceles.