B. Chertin et al., Endoscopic puncture of ureterocele as a minimally invasive and effective long-term procedure in children, EUR UROL, 39(3), 2001, pp. 332-336
Objectives: Over the past years the surgical approach to ureterocele has ev
olved from complicated major surgery to minimally invasive endoscopic treat
ment. Because of the high rate of secondary surgery in some recently report
ed series, an upper pole partial nephrectomy is again recommended as the pr
ocedure of choice. We have retrospectively evaluated the long-term results
of endoscopic puncture of a ureterocele and its long-term effectiveness and
applicability in children.
Methods: Over the past 8 years, 34 patients (20 female, 14 male) were treat
ed in our service with primary endoscopic puncture of a ureterocele. The me
an age of the patients was 1.1 +/- 4.3 (mean a SD) years. Mean follow-up wa
s 6.1 +/- 2.4 years. Antenatally ultrasound detected the ureterocele in 5 (
14%) patients, fetal hydronephrosis leading to the postnatal diagnosis in 1
3 (38%), and 16 (48%) children presented with symptoms of urinary tract inf
ection (UTI). The ureteroceles presented as part of renal duplication in 31
patients (91%), 3 (9%) in a single system and 1 child had bilateral ureter
oceles of a duplex system. Twenty (58%) children had intravesical ureteroce
les and the remaining 14 (42%) ectopic ureteroceles. Very poorly functionin
g upper pole moiety presented in 26 (75%) of the cases and nonfunctioning u
pper poles in 5 (14%). Twenty of 34 children (58%) had initial vesicoureter
al reflux (VUR) to the lower moiety, either to the ipsi (60%) or contralate
ral kidney (40%). A cold knife incision was carried out in 4 (11.7%), punct
ure by a 3-french Bugbee elctrode in 20 (58%), and the stylet of a 3-french
ureteral catheter was utilized to puncture the ureterocele in the remainin
g 10 patients (30.3%).
Results: Complete decompression of the ureterocele was observed in 32 of 34
children (94%). Two patients required secondary puncture 2 years following
the primary procedure and are doing well. Upper pole moiety function impro
ved postoperatively in 2 infants and remained stable in all 32 patients, no
patient presented with deterioration of the renal function. Six of 20 (30%
) patients who had initial VUR to the lower pole, accompanied with recurren
t UTI, required surgery. Three underwent ureteric reimplantation and anothe
r 3 submucosal polytetrafluoroethylene paste (Teflon) injection. Eight (40%
) patients presented with spontaneous resolution of VUR to the lower moiety
following puncture of the ureterocele. An additional 6 (17.6%) patients de
veloped VUR to the upper moiety following the puncture of the ureterocele,
3 after cold knife incision and 3 after simple puncture. In 2, submucosal T
eflon injection solved the VUR and the remaining 4 patients were maintained
on prophylactic antibiotics. In 1 child the reflux resolved spontaneously,
and none of them presented with UTI, In 2 cases with nonfunctional upper p
oles, partial nephrectomy was performed due to symptomatic UTI in spite of
complete collapse of the ureterocele 1 and 2 years, respectively, following
the initial puncture. No difference was observed in the re-operation rate
between the patients with ectopic versus intravesical ureterocele (p<0.05),
Conclusion: We found that endoscopic puncture of a ureterocele presents an
easily performed procedure which allows the release of obstructive ureters
and avoids major surgery in the majority of the cases even after a long fol
low-up, Copyright <(c)> 2001 S. Karger AG. Basel.