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Salehi-Pourmehr H, Lotfi B, Mohammad-Rahimi M, Tahmasbi F. Surgical patterns in the endoscopic management of pediatric ureterocele: A systematic review and meta-analysis. J Pediatr Urol 2024:S1477-5131(24)00195-5. [PMID: 38705762 DOI: 10.1016/j.jpurol.2024.04.005] [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: 09/13/2023] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To assess the results of endoscopic ureterocele treatments as well as the effects of ureterocele location (intravesical vs. ectopic) and anatomy (single vs. duplicated system) on treatment outcomes. MATERIAL AND METHODS Following the Systematic Reviews and Meta-Analyses (PRISMA) standards, several medical databases as well as Google Scholar were searched comprehensively. Studies describing secondary operation outcomes for endoscopic transurethral incision and puncture were included. Studies were required to compare patients according to ureterocele location (intravesical or ectopic) and anatomy (single or duplex system) or preoperative reflux. Meta-analysis was conducted using Comprehensive Meta-analysis (CMA) software. RESULTS A total of 83 studies entered this systematic review consisting of 3022 patients. According to the meta-analysis of 16 studies, the risk ratio (RR) of reoperation after ureterocele incision was significantly higher in patients with ectopic vs. intravesical ureteroceles (RR: 2.42; 95% CI: 1.89-3.11; P < 0.001; I2: 14.89%). Also, a higher reoperation rate was reported in patients with duplex system ureteroceles (DSU) vs. single system ureteroceles (SSU) with little heterogeneity based on 9 studies. (RR: 2.50; 95% CI: 1.60-3.91; P < 0.001; I2: 13.83%). CONCLUSION Our results showed that ectopic ureteroceles and duplex systems are associated with higher reoperation rates after endoscopic procedures.
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Affiliation(s)
- Hanieh Salehi-Pourmehr
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Behzad Lotfi
- Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran.
| | | | - Fateme Tahmasbi
- Research Center for Evidence-based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Chan A, Cassim N, Diljohn J, Rampersad FS, Ojar DH. The Radiographic Appearances of Bilateral Ureteroceles and Their Management in an Adult Patient Presenting With Recurrent Urinary Tract Infections. Cureus 2024; 16:e53487. [PMID: 38440017 PMCID: PMC10910575 DOI: 10.7759/cureus.53487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
A ureterocele is a congenital abnormality in which there is abnormal dilatation of the distalmost portion of the ureter, as it enters the urinary bladder. Patients present with frequent urinary tract infections, urinary retention, cyclical abdominal pains, failure to thrive, and hematuria. Ureteroceles are often diagnosed on antenatal ultrasound and sometimes postnatally on ultrasounds done in the setting of a urinary tract infection. This case describes a 51-year-old female who presented with recurrent urinary tract infections. Subsequent imaging with ultrasound, intravenous urogram, and computed tomography demonstrated features typical for bilateral ureteroceles.
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Affiliation(s)
- Adrian Chan
- Department of Radiology, The University of the West Indies, St. Augustine, TTO
| | - Nicolette Cassim
- Department of Radiology, The University of the West Indies, St. Augustine, TTO
| | - Jason Diljohn
- Department of Radiology, The University of the West Indies, St. Augustine, TTO
| | - Fidel S Rampersad
- Department of Radiology, The University of the West Indies, St. Augustine, TTO
| | - Devendra H Ojar
- Department of Radiology, The University of the West Indies, St. Augustine, TTO
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Faiz S, Zaveri MP, Perry JC, Schuetz TM, Cancarevic I. Role of Antibiotic Prophylaxis in the Management of Antenatal Hydronephrosis, Vesicoureteral Reflux, and Ureterocele in Infants. Cureus 2020; 12:e9064. [PMID: 32782882 PMCID: PMC7413314 DOI: 10.7759/cureus.9064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Widespread prenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. Antenatal hydronephrosis (AHN) and vesicoureteral reflux (VUR) are among the most common congenital anomalies diagnosed in utero or after birth. Pediatric urologists frequently rely on continuous antibiotic prophylaxis (CAP) for managing AHN, VUR, and ureterocele, unless definitive treatment is performed. The main aim of antibiotic prophylaxis (ABP) is to prevent urinary tract infection and long-term complications. Nevertheless, the efficacy of ABP has been a source of considerable debate, and pediatricians have varied opinions on who would benefit from ABP. In this review article, we searched the currently available literature, for evidence of the role of ABP in the setting of AHN, VUR, and ureterocele. Most of our studies showed a limited benefit of ABP for HN and VUR. The data on the use of CAP in the management of ureterocele is scarce. However, due to the involvement of independent risk factors and other variables, a conclusion cannot be drawn from these studies alone. Pediatric urologists are urged to conduct randomized controlled trials to compare patients followed up with and without ABP. Given the lack of guidelines, an individualized approach should be used for the use of ABP, until precise guidelines and recommendations are developed.
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Affiliation(s)
- Sadaf Faiz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mitul P Zaveri
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jamal C Perry
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tayná M Schuetz
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ivan Cancarevic
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Caione P, Gerocarni Nappo S, Collura G, Matarazzo E, Bada M, Del Prete L, Innocenzi M, Mele E, Capozza N. Minimally Invasive Laser Treatment of Ureterocele. Front Pediatr 2019; 7:106. [PMID: 31024867 PMCID: PMC6463783 DOI: 10.3389/fped.2019.00106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/06/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction: Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy. Materials and methods: Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5-0.8 joule energy, through 8-9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18-24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6-18 months in selected cases. Statistical analysis was utilized for data evaluation. Results: From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1-168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6-18 months follow-up for recurrent dilatation. Urinary tract infections and de novo refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls (p < 0.05). Further surgery was required in 12 patients (18%) at 1-5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group (p < 0.05). Conclusions: Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery.
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Affiliation(s)
- Paolo Caione
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Simona Gerocarni Nappo
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Giuseppe Collura
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Ennio Matarazzo
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Maida Bada
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Laura Del Prete
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Michele Innocenzi
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Ermelinda Mele
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
| | - Nicola Capozza
- Division of Pediatric Urology, Department of Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy
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