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Yin X, Yang Y. Risk factors for postoperative adverse outcomes and secondary surgery in pediatric patients with unilateral ectopic ureterocele associated with the duplex system. J Pediatr Urol 2023; 19:88.e1-88.e8. [PMID: 36336622 DOI: 10.1016/j.jpurol.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/27/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Ectopic ureterocele management in children remains a controversial subject without a clear consensus. The purpose of this study was to explore the risk factors for adverse outcomes and secondary surgery in pediatric patients with unilateral ectopic duplex system ureterocele, a complex urinary system deformity with controversial treatment. MATERIALS AND METHODS We retrospectively reviewed 75 patients with unilateral ectopic duplex system ureterocele who underwent surgery at the Shengjing Hospital of China Medical University between January 1, 2008, and September 31, 2020. Demographic characteristics, preoperative data, surgical procedures, postoperative adverse outcomes, and secondary surgery were recorded. Adverse outcomes were defined as new-onset VUR and BOO after surgery. The risks of adverse outcomes and secondary surgery were evaluated using multivariate binary logistic regression and expressed as adjusted odds ratios with 95% confidence intervals. RESULTS Adverse outcomes occurred in 25 (33.3%) patients, including 24 (32.0%) with new-onset vesicoureteral reflux and 1 (1.3%) with bladder outlet obstruction. Seven (9.3%) patients required secondary surgery. The independent risk factors for adverse outcomes were transurethral endoscopic incision and transurethral endoscopic puncture (transurethral endoscopic incision vs. upper pole partial nephrectomy: OR = 11.049, P = 0.004; transurethral endoscopic puncture vs. upper pole partial nephrectomy: OR = 33.222, P = 0.002). DISCUSSION The definitive treatment for duplex system ureterocele remains controversial. We found that transurethral endoscopic incision or puncture was an independent risk factor for adverse outcomes. The main limitation of this study would be its retrospective nature and relatively short follow-up period. Furthermore, 30 children were younger than 5 years at last follow up, and thus, we could not efficiently evaluate their voiding function. CONCLUSIONS Transurethral endoscopic incision or puncture is effective for decompressing the obstruction of the upper urinary tract in acute urosepsis in ectopic duplex system ureterocele. Although more than half of patients with unilateral ectopic duplex system ureterocele suffered from new-onset vesicoureteral reflux after transurethral endoscopic incision or puncture, few of them required secondary surgery.
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Affiliation(s)
- Xiaoming Yin
- Department of Pediatric Urology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning province 110004, China
| | - Yi Yang
- Department of Pediatric Urology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang City, Liaoning province 110004, China.
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Evaluation of Pediatric Patients with a Diagnosis of Ureterocele. Pediatr Rep 2022; 14:533-537. [PMID: 36548205 PMCID: PMC9783867 DOI: 10.3390/pediatric14040062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Aim: The presence and clinical importance of vesicoureteric reflux in patients with a double collecting system are being questioned. Therefore, the role of voiding cystourethrography in the management of patients with ureterocele is unclear. This study aimed to evaluate patients with a ureterocele in terms of urinary tract infection (UTI) and vesicoureteral reflux (VUR). Material Methods: The cases who were admitted to the Pediatric Nephrology Clinic of Health Sciences University Tepecik Training and Research Hospital between 2012 and 2022 and were diagnosed with ureterocele were evaluated retrospectively. Demographic, clinical, and laboratory data were obtained from file records. Results: All patients diagnosed with ureterocele and voiding cystourethrography (VCUG) were evaluated. A total of 24 (female 13 (54.2%)) children were included. The reasons for admission were antenatal hydronephrosis in 13 (54.2%) patients, UTI in 9 (37.5%) patients, and incidentally diagnosed ureterocele in 2 (8.3%) patients. Urinary tract infection was observed in 20 patients at admission, recurrent UTI in 21 patients at follow-up, preoperative pyelonephritis in 12 patients. VUR was found in 11 patients, and severe VUR (≥stage 3) was found in 9 patients. Ten patients had ipsilateral hydronephrosis, and 14 patients had a double collecting system. The presence of VUR was found to be associated with female gender, UTI at admission, and recurrent UTI at follow-up (p < 0.05). However, there was no difference between groups with or without VUR in terms of ipsilateral hydronephrosis, scar formation, and the need for surgery (p > 0.05). Conclusions: We could not demonstrate any criteria to select patients to receive VCUG; on the other hand, VUR did not cause more kidney damage. Our study supports the need for more scientific data to determine management in patients with ureterocele.
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Pogorelić Z, Todorić J, Budimir D, Saraga M. Laser-puncture of the ureterocele in neonatal patients significantly decreases an incidence of de novo vesico-ureteral reflux than electrosurgical incision. J Pediatr Urol 2021; 17:492.e1-492.e6. [PMID: 33741240 DOI: 10.1016/j.jpurol.2021.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Endoscopic laser-puncture or electrosurgical incision are the most commonly used minimaly invasive approaches for the treatment of the ureterocele. Both techniques are mainly successful in decompressing of ureteroceles, but the consequence of such treatment may be formation of de novo vesicoureteral reflux and febrile urinary tract infection which could impact the final results. OBJECTIVE To compare outcomes of treatment of two endoscopic techniques used in management of neonatal patients with intravesical ureterocele. STUDY DESIGN A case records of 64 neonates who underwent endoscopic procedures for intravesical ureterocele, performed at our institution from January 2005 to January 2021, were retrospectively reviewed. The patients were divided in two groups depending on used endoscopic procedure. The first group (n = 41) consisted of patients who underwent electrosurgical incision of the ureterocele, while the second group (n = 23) consisted of patients in whom 6 to 8 laser-punctures of the ureterocele were performed. The groups were compared in regards to outcomes of treatment, with special emphasis on de novo vesicoureteral reflux and the need for further treatment and surgery. RESULTS Median follow-up was 7.5 (IQR 3, 11.5) and 3.5 (IQR 1.5, 5) years in the electroincision and laser-puncture groups, respectively (P = 0.017). No significant differences between the groups in regards to medians of duration of surgery (12 min vs. 11 min, P = 0.670), length of hospital stay (2 days in both groups, P = 0.988) or postoperative obstruction (n = 1 vs. n = 0, P > 0.999) were recorded. Ureterocele decompression was achieved after endoscopic treatment in 87.9% and 100% of the patients in electrosurgery and laser-puncture groups, respectively (P = 0.150). Five patients (12.1%) from electrosurgery group required endoscopic retreatment. The laser-puncture group had a significantly decreased rate of de novo vesicoureteral reflux (8.7% vs. 58.5%; P = 0.0001) and lower incidence of subsequent surgery due to de novo vesicoureteral reflux (50% vs. 62.5%; P = 0.727). CONCLUSION Both electrosurgical incision and laser-puncture endoscopic techniques are safe and effective in relieving the obstruction. Laser-puncture technique is associated with significantly lower incidence of de novo vesicoureteral reflux and accordingly fewer invasive procedures for neonatal patients.
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Affiliation(s)
- Zenon Pogorelić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia; Department of Surgery, University of Split, School of Medicine, Split, Croatia.
| | - Jakov Todorić
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Dražen Budimir
- Department of Pediatric Surgery, University Hospital of Split, Split, Croatia
| | - Marijan Saraga
- Department of Pediatris, University Hospital of Split, Split, Croatia; Department of Pediatris, University of Split, School of Medicine, Split, Croatia
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Comparison of electrocautery versus holmium laser energy source for transurethral ureterocele incision: an outcome analysis from a tertiary care institute. Lasers Med Sci 2020; 36:521-528. [PMID: 32494979 DOI: 10.1007/s10103-020-03051-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Transurethral endoscopic incision is an established treatment option for management of obstructing ureterocele. It can be performed using monopolar electrocautery or holmium laser as an energy source. The present study was carried out to evaluate outcomes of transurethral ureterocele incision (TUI) by two different energy sources, i.e., monopolar electrocautery versus holmium laser. A retrospective review of the data of all patients who underwent endoscopic TUI from 2007-2017 was performed. Preoperative clinical, biochemical, and radiological characteristics and operative parameters were reviewed and compared between the two groups. Associated stone in the ureterocele was fragmented using pneumatic lithotripter or Mauermeyer stone punch forceps in the electrocautery group and holmium laser in the laser group. Statistical analysis was performed using IBM SPSS version 21.0. Chi-squared test was used for categorical/dichotomous variables. Unpaired t test was used for continuous variables. Out of total 44 patients, 28 patients had duplex system ureterocele and 16 patients had single system ureterocele. Mean age was 18.5 + 7.4 years (range 14-26 years). Six patients had associated stones in the ureterocele. Most common presentation was flank pain followed by urinary infections and bladder outlet obstruction. Preoperative vesico-ureteric reflux was seen in 18% patients. Monopolar TUI was performed in 20 patients and laser-TUI in 24 patients. Three patients had associated stone in ureterocele in each group. Fragmentation of stone was successfully done with holmium laser without changing the instrument and with less associated surgical morbidity in the laser group. Postoperative successful decompression was evident in 38 (90%) patients. Renal parenchyma thickness was improved on ultrasound scan and renal scan showed non-obstructed system in all patients at follow-up. Both laser and monopolar incision have similar efficacy in decompressing the ureterocele in long-term follow-up. However, laser has added advantage of stone lithotripsy with the same instruments with lesser morbidity and lower incidence of persistent reflux.
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Maruo K, Nishinaka K. Conservative treatment of asymptomatic ectopic ureterocele: A report of two cases. IJU Case Rep 2020; 3:40-43. [PMID: 32743466 PMCID: PMC7292162 DOI: 10.1002/iju5.12137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There are no established treatments for asymptomatic ectopic ureteroceles, with completely duplicated ureters, during the neonatal period and infancy. However, conservative treatment is sometimes successful. CASE PRESENTATION Two patients were prenatally diagnosed, via ultrasonography, with left hydronephrosis. In each case, magnetic resonance imaging confirmed an ectopic ureterocele accompanying the left, completely duplicated ureter. Prophylactic antibiotics were administered and conservative treatment was started. Currently, one patient is 44 months old and the other is 49 months old; in neither patient has the ureterocele or hydronephrosis been exacerbated. CONCLUSION Patients with (i) a nonfunctional kidney, (ii) mild hydronephrosis or moderate vesicoureteral reflux, (iii) no bladder neck obstruction on urination, and (iv) a Churchill classification ≤Grade II (Churchill classification) may be able to select conservative treatment.
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Affiliation(s)
- Kazutaka Maruo
- Department of Pediatric UrologyHokkaido Medical Center for Child Health and RehabilitationSapporoHokkaidoJapan
- Department of UrologySapporo Medical UniversitySapporoHokkaidoJapan
| | - Kazuyuki Nishinaka
- Department of Pediatric UrologyHokkaido Medical Center for Child Health and RehabilitationSapporoHokkaidoJapan
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Luo J, Tan XH, Liu X, He DW, Lin T, Li XL, Wei GH. Anatomy and management of upper moiety vascular variation in children with duplex kidney. J Pediatr Surg 2019; 54:2130-2133. [PMID: 31072676 DOI: 10.1016/j.jpedsurg.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/20/2019] [Accepted: 04/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the upper pole vascular anatomy of duplex kidney and provide our experience with laparoscopic upper pole partial nephrectomy (LUPPN). METHODS A retrospective study was performed among patients with duplex kidney who underwent computed tomography angiography at one single institution, some of whom were subsequently treated with LUPPN. According to imaging results and intraoperative findings, the arterial supply to the upper moiety of a duplex system was classified based on number and branching pattern. RESULTS A total of 84 children were included in the study. Twenty patients (23.8%) were managed conservatively and LUPPN in lateral position was performed in the others. All laparoscopic procedures were successfully completed as planned without conversion. No major intraoperative complications occurred. Of these patients, 68 cases (73.1%) were supplied with one branch of the renal artery. The vascular anatomy of duplex kidney was classified into three patterns according to the variation of arteries. In 71 cases (76.3%), the renal artery separated into two or more arteries near the renal parenchyma, called perihilar arterial branching. Other branching patterns featured accessory renal arteries and branches of the adrenal artery. Gender was not significantly associated with the vascular number (p = 0.19) and the pattern of variation (p = 0.83). CONCLUSIONS LUPPN is an effective technique for children with duplex kidney. The upper renal moiety is mainly supplied by one branch of the renal artery and the most common pattern is perihilar arterial branching. Determining vascular variation before surgery might be beneficial to avoid intraoperative hemorrhage and accidental vessel injury. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jin Luo
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Hui Tan
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Da-Wei He
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Liang Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guang-Hui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China; Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
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Aikins K, Taghavi K, Grinlinton M, Reed P, Price N, Upadhyay V. Cystoscopic transurethral incision in simplex and duplex ureteroceles-is it the definitive procedure? J Pediatr Urol 2019; 15:560.e1-560.e6. [PMID: 31402102 DOI: 10.1016/j.jpurol.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the efficacy of primary cystoscopic transurethral incision (CTUI) in the management of paediatric ureteroceles. The secondary aim is to compare the efficacy of CTUI between simplex and duplex systems. PATIENTS AND METHODS This is a retrospective review of consecutive paediatric patients requiring surgical intervention for ureterocele. Data collected for analysis included demographics, diagnostic, pre-operative investigations, operative interventions and postoperative variables. RESULTS Over a 19-year period, 79 consecutive cases were identified, and 42 were male (53.2%). The mean follow-up was 6.7 years. Seventy-three (92.4%) cases underwent primary CTUI; 50 of these cases (68.5%) required no further procedures during the study period. Sixty-one cases were treated by endoscopic intervention alone (77.2%). Forty-one (51.9%) cases had a simplex system, and 38 (48.1%), a duplex system. There was no statistically significant difference in the efficacy of primary CTUI in simplex vs duplex systems. Of the 20 patients who had pre-operative and postoperative micturating cystourethrograms performed, seven (35%) developed de-novo postoperative vesicoureteric reflux after CTUI. CONCLUSION Primary CTUI is a safe, minimally invasive procedure that is definitive in the majority of children presenting with a ureterocele that requires intervention. There was no difference in success of primary CTUI between simplex or duplex systems.
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Affiliation(s)
- K Aikins
- Department of Paediatric Surgery, Starship Children's Health, Auckland, New Zealand.
| | - K Taghavi
- Department of Paediatric Surgery, Starship Children's Health, Auckland, New Zealand
| | - M Grinlinton
- Department of Paediatric Surgery, Starship Children's Health, Auckland, New Zealand
| | - P Reed
- Children's Research Centre, Starship Children's Health, Auckland, New Zealand
| | - N Price
- Department of Paediatric Surgery, Starship Children's Health, Auckland, New Zealand
| | - V Upadhyay
- Department of Paediatric Surgery, Starship Children's Health, Auckland, New Zealand
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Bayne CE, Majd M, Rushton HG. Diuresis renography in the evaluation and management of pediatric hydronephrosis: What have we learned? J Pediatr Urol 2019; 15:128-137. [PMID: 30799171 DOI: 10.1016/j.jpurol.2019.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/27/2018] [Accepted: 01/17/2019] [Indexed: 11/29/2022]
Abstract
Diuresis renography (DR) is widely used in the evaluation of hydronephrosis and hydroureter in infants and children. The goal of this provocative nuclear imaging examination should be to detect the hydronephrotic kidneys at risk for loss of function and development of pain, hematuria, and urinary tract infection. The reliability of DR is dependent on the acquisition and processing of the data as well as interpretation and utilization of the results. In this review, the key concepts of standardized DR and pitfalls to avoid are highlighted.
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Affiliation(s)
- C E Bayne
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | - M Majd
- Department of Radiology, Children's National Health System, Washington, DC, USA
| | - H G Rushton
- Division of Pediatric Urology, Children's National Health System, Washington, DC, USA.
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Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems. World J Urol 2019; 37:2237-2244. [DOI: 10.1007/s00345-018-2607-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/13/2018] [Indexed: 11/26/2022] Open
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Andrioli V, Guerra L, Keays M, Keefe DT, Tang K, Sullivan KJ, Garland K, Rafikov M, Leonard MP. Active surveillance for antenatally detected ureteroceles: Predictors of success. J Pediatr Urol 2018; 14:243.e1-243.e6. [PMID: 29580731 DOI: 10.1016/j.jpurol.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 02/05/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Historically, ureteroceles were surgically treated, as patients were diagnosed after developing symptoms. However, with the advance of fetal medicine, antenatal detection has provided an opportunity to look at the natural history of ureteroceles. OBJECTIVES With data derived from a retrospective chart review of patients with ureteroceles that were detected antenatally, the current study aimed to determine which group of children would be at risk for failure on active surveillance. It was hypothesized that single system ureteroceles (SSU) and male patients with duplex system ureteroceles (DSU) would be ideal for observation. METHODS Outcomes were assessed by descriptive statistics. Kaplan-Meier curves were utilized to estimate median duration on active surveillance in both single and duplex cohorts. Breakthrough febrile urinary tract infection (fUTI) and surgery were determined by Cox regression in the duplex system cohort. Surgery was considered surveillance failure. RESULTS A total of 102 patients (64 females/38 males) met the criteria: 78 (76.5%) had DSU and 24 (23.5%) SSU. The overall median observation was 1.2 years (range 0.7-3.1). Follow-up ranged from 0.3 to 11.7 years for SSU, and from 0.02 to 17.3 years for DSU. The predictors of failure of active surveillance (AS) in DSU (surgical intervention) were male gender (HR 1.8, 1.0-3.3, P = 0.037), or fUTI (HR 3.1, 1.7-5.8, P = 0.002). Predictors of fUTI were contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter (OR 9.5, 1.2-71.7, P = 0.028). Interestingly, vesicoureteral reflux (VUR) was not a predictor of fUTI. The SSU patients were ideal for AS, while in DSU, surveillance was successful in 30% of patients who were primarily females without contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter. However, in contradiction to the hypothesis, males were at higher risk for surgical intervention in the DSU cohort. CONCLUSION Active surveillance is an option for patients with antenatally detected ureteroceles, but careful long term follow up is mandatory. Parents should be advised that surgical intervention may still be necessary, particularly in males with DSU.
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Affiliation(s)
- V Andrioli
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - L Guerra
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - M Keays
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - D T Keefe
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - K Tang
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - K J Sullivan
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - K Garland
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - M Rafikov
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - M P Leonard
- Division of Urology, Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
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Le HK, Chiang G. Long-term Management of Ureterocele in Duplex Collecting Systems: Reconstruction Implications. Curr Urol Rep 2018; 19:14. [DOI: 10.1007/s11934-018-0758-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Ellison JS, Lendvay TS. Robot-assisted ureteroureterostomy in pediatric patients: current perspectives. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:45-55. [PMID: 30697563 PMCID: PMC6193430 DOI: 10.2147/rsrr.s99536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Developments in pediatric robotic surgery have increased the feasibility of minimally invasive surgery for complex urinary tract reconstruction. Ureteroureterostomy is a commonly employed strategy for the management of a duplicated ureteral system with either upper pole obstruction or lower pole vesicoureteral reflux, and this approach minimizes the risk to a healthy ureter as might be seen in a common sheath ureteral reimplant and avoids complex dissection around the renal hilum as with a heminephrectomy. The robotic platform enables optimum instrument manipulation for an end-to-side ureteral anastomosis as well as excellent visualization deep into the pelvis for excision of the distal ureteral stump. In this study, the indications and preoperative evaluation for pediatric robotic ureteroureterostomy (RUU) were described and intraoperative considerations for a successful repair were highlighted. In order to assess the outcomes, a PubMed search was performed to find the articles focusing on RUU in the pediatric population. The institutional experience of the authors was also reviewed. As with an open procedure, both minimizing dissection on the recipient ureter and ensuring a tension-free, watertight anastomosis are key principles to minimize complications. Although port placement is similar to that in robotic pyeloplasty, small adjustments may need to be made to ensure access to the pelvis. An assistant port and/or traction sutures is often used to aid in the dissection and anastomosis. RUU was first described in 2008, and several reports have demonstrated positive short-term results. However, median follow-up times are limited with most series reporting outcomes <1 year postoperatively. A future study is required to establish the long-term efficacy of this procedure and define the optimum patient population for a robotic approach.
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Affiliation(s)
- Jonathan S Ellison
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
| | - Thomas S Lendvay
- Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA,
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Upper Pole Heminephrectomy Versus Lower Pole Ureteroureterostomy for Ectopic Upper Pole Ureters. Curr Urol Rep 2017; 18:21. [DOI: 10.1007/s11934-017-0664-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Smakal O, Sarapatka J, Hartmann I, Vencalek O, Flogelova H, Koranda P, Student V. Can renal ultrasonography and DMSA scintigraphy be used for the prediction of irreversible histological lesions of the upper pole in duplex system with ureteroceles or ectopic ureters? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160:429-34. [DOI: 10.5507/bp.2016.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 04/27/2016] [Indexed: 11/23/2022] Open
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Evaluation of the Initial Treatment of Ureteroceles. Urology 2016; 89:113-7. [DOI: 10.1016/j.urology.2015.11.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 11/22/2022]
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Thambidorai CR, Teoh TH, Annuar ZM. Spontaneous resolution of antenatally diagnosed ureterocele. J Indian Assoc Pediatr Surg 2015; 20:51-2. [PMID: 25552835 PMCID: PMC4268760 DOI: 10.4103/0971-9261.145558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Tammy Hq Teoh
- Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Zulfiqar M Annuar
- Department of Radiology, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Boucher A, Cloutier J, Rousseau A, Charrois R, Bolduc S. Is an initial endoscopic treatment for all ureteroceles appropriate? J Pediatr Urol 2013; 9:339-43. [PMID: 22687344 DOI: 10.1016/j.jpurol.2012.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 04/19/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A systematic initial endoscopic approach has been locally adopted since 2002 for the treatment of ureterocele. Our aim was to compare outcomes for patients treated with this approach to those treated prior to this date. METHODS We reviewed the charts of 145 children with ureteroceles treated surgically between 1992 and 2010. Patients were divided according to ureterocele position, year of treatment and type of initial intervention. Evaluation was completed by ultrasound, voiding cystourethrogram and nuclear renal scans. RESULTS Mean age at initial surgery was 18 months. Group 1 comprised 68 patients operated before 2002, and Group 2 66 patients operated after 2002. Group 1 patients showed a higher rate of preoperative vesicoureteral reflux. Mean follow-up was 43 and 25 months for group 1 and 2, respectively. Ureteroceles treated endoscopically underwent secondary procedures in 61% (group 1) and 42% (group 2) for ectopic and in 42% (group 1) and 10% (group 2) for orthotopic ureteroceles. Overall, there was more de novo upper moiety VUR in group 1 (48% vs 12%). CONCLUSION Primary endoscopic ureterocele treatment seems to be an appropriate option for children with a clinically significant ureterocele. The rate of secondary procedures was higher for ectopic ureteroceles but acceptable compared to the upper tract approach.
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Affiliation(s)
- Andréanne Boucher
- Division of Urology, Centre Hospitalier Universitaire de Québec, Université Laval, 2705 boulevard Laurier, R-1742, Québec, Canada.
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Castagnetti M, Cimador M, Esposito C, Rigamonti W. Antibiotic prophylaxis in antenatal nonrefluxing hydronephrosis, megaureter and ureterocele. Nat Rev Urol 2012; 9:321-9. [DOI: 10.1038/nrurol.2012.89] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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An all-endo Approach to Complete Ureteral Duplications Complicated by Ureterocele and/or Vesicoureteral Reflux: Feasibility, Limitations, and Results. Int J Pediatr 2011; 2011:103067. [PMID: 22220183 PMCID: PMC3246730 DOI: 10.1155/2011/103067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 11/01/2011] [Indexed: 11/29/2022] Open
Abstract
Purpose. Totally endoscopic management (all-endo) of patients with a duplicated renal system (DS) associated with severe vesicoureteral reflux (VUR) or obstructive ureterocele (UC) is an attractive alternative to traditional open procedures. The authors discuss feasibility and results of an all-endo approach on a consecutive series of patients. Methods. From 1999 to 2009, all patients with a complete DS associated with UC and/or VUR were proposed for primary all-endo approach. UC puncture was performed using a 3 Fr Bugbee electrode. Deflux (dextranomer/hyaluronic acid copolymer) injection was administered for VUR. The need for secondary surgery was evaluated on followup. Results. Of the 62 patients recruited, 46 were treated using a primary all-endo approach and 16 patients received no treatment. Of the 46 treated patients with 56 affected renal units, 32 (97%) UCs collapsed following puncture and 29 (63%) VURs were resolved or downgraded. Secondary VUR occurred in 13 (39%) renal units. Secondary surgery was performed on 23 (41%) renal units. Conclusion. The all-endo approach for VUR in DS is an effective therapeutic option. UC collapse was achieved by puncture in most of the patients; secondary VUR was the main complication in a small group of extravesical UC.
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Pearce R, Subramaniam R. Partial nephroureterectomy in a duplex system in children: the need for additional bladder procedures. Pediatr Surg Int 2011; 27:1323-6. [PMID: 21877243 DOI: 10.1007/s00383-011-2968-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heminephroureterectomy (HN) is our treatment of choice in a duplex system with non-functioning moiety. We examined the need for endoscopic incision (EI)/bladder reconstructive surgery (BRS) and whether ureteroceles and/or vesicoureteric reflux (VUR) influenced management options. METHODS Retrospective study of patients undergoing HN by a single surgeon (2003-2008). Patients were classified according to the presence (Group 1) or absence (Group 2) of ureterocele. The groups were subdivided with coexisting dilating VUR (a) or not (b). Statistical analysis included Fisher's exact test. RESULTS Thirty-one children were identified. Seventeen (54.8%) had ureterocele (Group 1) and 14 patients had no ureterocele (Group 2). Group 1 had eight with VUR (1a) and nine without (1b). Group 2 had seven with VUR (2a) and seven without (2b). Significantly more patients with ureterocele required EI/BRS (p = 0.006). Five (29%) in Group 1 required BRS versus none in Group 2 (p = 0.04). Six (75%) in Group 1a underwent EI/BRS versus three (33%) in Group 1b (p = 0.15). Significantly more in Group 1a required EI prior to HN versus Group 1b (p = 0.04). Similar numbers of patients required BRS in Groups 1a and 1b (p = 0.61). CONCLUSIONS In the absence of ureterocele, there is minimal likelihood of requiring surgery apart from HN, independent of VUR. Presence of ureterocele is an indicator for additional procedure within the bladder. There is a higher incidence of EI when ureterocele co-exists with dilating VUR.
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Affiliation(s)
- R Pearce
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Adorisio O, Elia A, Landi L, Taverna M, Malvasio V, Danti AD. Effectiveness of Primary Endoscopic Incision in Treatment of Ectopic Ureterocele Associated With Duplex System. Urology 2011; 77:191-4. [DOI: 10.1016/j.urology.2010.02.061] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 02/23/2010] [Accepted: 02/23/2010] [Indexed: 11/24/2022]
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Palese A, Buchini S, Deroma L, Barbone F. The effectiveness of the ultrasound bladder scanner in reducing urinary tract infections: a meta-analysis. J Clin Nurs 2010; 19:2970-2979. [DOI: 10.1111/j.1365-2702.2010.03281.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Merguerian PA, Taenzer A, Knoerlein K, McQuiston L, Herz D. Variation in Management of Duplex System Intravesical Ureteroceles: A Survey of Pediatric Urologists. J Urol 2010; 184:1625-30. [DOI: 10.1016/j.juro.2010.03.113] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Paul A. Merguerian
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Andreas Taenzer
- Department of Anesthesia, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Kimberley Knoerlein
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Leslie McQuiston
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Daniel Herz
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Thomas DFM. Prenatal diagnosis: what do we know of long-term outcomes? J Pediatr Urol 2010; 6:204-11. [PMID: 20347395 DOI: 10.1016/j.jpurol.2010.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
Although prenatal diagnosis has been a prominent feature of Paediatric Urology for more than two decades the published literature has been largely characterized by studies reporting short to medium-term follow up. This deficiency is now being addressed by the growing availability of published and unpublished long-term outcome data for a range of prenatally detected anomalies. This review analyses the evidence on long-term outcomes which is provided by studies with mean or median follow- up exceeding 5 years, with particular emphasis on the small number of studies reporting follow -up at 10 years and beyond. The natural history and outcome of conservatively managed uropathies is considered in conjunction with an appraisal of evidence- based indications for surgical intervention. This review evaluates the relative benefits and drawbacks of prenatal diagnosis for children and their parents and also considers the impact of prenatal diagnosis on the delivery of Paediatric Urological services and specialist training.
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Affiliation(s)
- D F M Thomas
- Department of Paediatric Urology, Clinical Sciences Building, St James's University Hospital, Leeds LS9 7TF, UK.
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26
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Complete Excision or Marsupialization of Ureteroceles: Does Choice of Surgical Approach Affect Outcome? J Urol 2008; 180:1819-22; discussion 1822-3. [DOI: 10.1016/j.juro.2008.04.078] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Indexed: 11/17/2022]
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Wang MH, Greenfield SP, Williot P, Rutkowski J. Ectopic ureteroceles in duplex systems: long-term follow up and 'treatment-free' status. J Pediatr Urol 2008; 4:183-7. [PMID: 18631922 DOI: 10.1016/j.jpurol.2007.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Accepted: 12/08/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Definitive treatment of ectopic ureterocele (EU) implies that no further surgery or prophylactic antibiotic is needed. The literature is unclear on which interventions render a child 'treatment free'. MATERIALS AND METHODS Thirty (23 female, seven male) patients presented between 1984 and 2000. Follow up ranged from 5 to 15 years (mean: 7). Presenting reasons were: urinary tract infection in 18 (16 females, two males; age: 17<6 months, one 2 years), prenatal ultrasound in 11 (seven females, four males), and renal failure in one (male, aged 3 weeks). RESULTS Treatment was as follows. No intervention, three (10%). Single procedure, eight (27%): five hemi-nephrectomy (HN), two transurethral incisions (TUI), one excision and re-implantation (E&R). Two procedures, 14 (47%): first procedure 10 TUI, 4 HN; second procedure 13 E&R, 1 TUI. Three procedures, three (10%): first 2 TUI, 1 HN; second 3 TUI; third 2 E&R, 1 HN. Four procedures, two (7%): first 2 TUI; second 1 HN, 1 TUI; third 2 TUI; fourth 2 E&R. Eight (27%) remained on prophylaxis: two had no intervention, in 4 the ectopic ureterocele was in situ after HN or TUI, and two had reflux after E&R. Twenty two (73%) came off prophylaxis (16 E&R, 4 HN, 1 TUI, 1 observation). Poorly or non-functioning upper pole moieties were left in place in 14/18 who underwent E&R. CONCLUSION 'Treatment-free' status most often requires ureterocele excision. HN alone can be definitive, while TUI alone is so rarely. Poor or non-functioning upper pole segments can remain after E&R. Children with collapsed ureteroceles in situ often must remain on antibiotic prophylaxis. A staged approach with initial TUI, followed by E&R, was successful in definitively treating the majority.
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Affiliation(s)
- Ming-Hsien Wang
- Department of Pediatric Urology, Women & Children's Hospital of Buffalo, State University of New York at Buffalo School of Medicine & Biomedical Sciences, Buffalo, NY, USA
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Hubert KC, Palmer JS. Current diagnosis and management of fetal genitourinary abnormalities. Urol Clin North Am 2007; 34:89-101. [PMID: 17145364 DOI: 10.1016/j.ucl.2006.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prenatal assessment with ultrasonography provides excellent imaging of fluid-filled structures (eg, hydronephrosis, renal cysts, and dilated bladder) and renal parenchyma. This information allows for the generation of a differential diagnosis, identification of associated anomalies, and assessment of the prenatal and postnatal risks of a given anomaly. This enhances parental education and prenatal and postnatal planning. This article discusses the current methods of diagnosis and management of fetal genitourinary anomalies, and also the postnatal evaluation and treatment of these conditions.
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Affiliation(s)
- Katherine C Hubert
- Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Kim HJ, Lee HY, Han SW. Postoperative Outcome of the Upper Pole Kidney with a Complete Ureteral Duplication and Complicated with Ureterocele or Ectopic Ureter after Pyeloureterostomy. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.11.1155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hyung Joon Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Young Lee
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Won Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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30
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Oh TH, Ryu DS, Kwon JO. Clinical Manifestations and Indications for Management of Ureteroceles in Adults. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.3.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Tae Hee Oh
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Dong Soo Ryu
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Jun O Kwon
- Department of Urology, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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Direnna T, Leonard MP. Watchful Waiting for Prenatally Detected Ureteroceles. J Urol 2006; 175:1493-5; discussion 1495. [PMID: 16516032 DOI: 10.1016/s0022-5347(05)00676-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE Ureteroceles are commonly detected by prenatal ultrasound. Although many require surgical intervention due to obstruction of more than one renal moiety or obstruction of the bladder neck, some may be carefully observed. The objective of this study was to assess the outcome of conservative management in select cases of prenatally detected ureteroceles at a tertiary care pediatric hospital. MATERIALS AND METHODS We retrospectively reviewed the charts of patients with ureteroceles detected on prenatal ultrasound who were treated nonsurgically between 1990 and 2001. RESULTS A total of 10 cases were detected in the course of the chart review, with 6 involving duplex system and 4 involving single system ureteroceles. Median followup was 5 years (range 1 to 11). Patients were followed with routine ultrasound at 3 to 6-month intervals for the first 2 years, and at 6-month to 2-year intervals thereafter. Voiding cystourethrogram and renal scans or IVPs were performed initially in all patients. Those with vesicoureteral reflux were followed with annual or biennial cystogram until reflux resolution. Antibiotic prophylaxis was routinely prescribed for an average duration of 1.5 years. Initial ultrasound revealed unilateral hydronephrosis in all patients, with complete resolution in 6 during a mean followup of 2 years. Voiding cystourethrogram demonstrated vesicoureteral reflux of grade III or less in 4 patients. Reflux resolved in 2 of these patients during a mean followup of 3 years. No patient required surgical intervention within the time frame of this study. CONCLUSIONS There may be a role for watchful waiting in select cases of prenatally detected ureteroceles. Cases involving obstruction of more than one renal moiety, bladder neck obstruction or high grade vesicoureteral reflux were not selected among the population we followed, and would likely require initial surgical management. Patients without these complicating features may be safely followed on suppressive antibiotics, as based on our experience many of the associated problems may resolve without surgical intervention.
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Affiliation(s)
- Tania Direnna
- Division of Pediatric Urology, Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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