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Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems
1Section of Urology, Columbus Children's Hospital, Ohio State University, USA.
Insights
Transurethral puncture of ectopic ureteroceles offers temporary relief from upper pole obstruction but often necessitates further surgical intervention. Long-term follow-up reveals that many children require open surgery due to persistent or developing reflux.
Area of Science:
- Pediatric Urology
- Surgical Outcomes
- Congenital Abnormalities
Background:
- Ectopic ureteroceles, particularly those associated with duplex systems, can cause significant urinary tract issues in children.
- Transurethral puncture is a minimally invasive approach, but its long-term efficacy requires evaluation.
Purpose of the Study:
- To assess the long-term outcomes of transurethral puncture for ectopic ureteroceles in duplex systems.
- To determine the need for subsequent interventions after initial puncture therapy.
Main Methods:
- Retrospective review of patient records undergoing transurethral puncture for ectopic ureterocele.
- Exclusion of orthotopic, bilateral, and prolapsing ureteroceles.
- Analysis of pre- and post-operative reflux, need for repeat procedures, and open surgery.
Main Results:
- 19 girls and 2 boys underwent the procedure, with common presentations including prenatal hydronephrosis and urinary tract infections.
- Post-procedure, 48% developed reflux into the ureterocele/upper pole; 71% ultimately required open surgery.
- Repeat puncture was needed in 20% for persistent obstruction; 15 patients required ureterocele excision and reimplantation.
Conclusions:
- Transurethral puncture provides short-term relief but is not a definitive treatment for most ectopic ureteroceles.
- A significant proportion of children develop new or recurrent reflux, necessitating open surgical correction.
- Long-term follow-up is crucial as reflux can develop or progress years after the initial puncture.
Purpose:
We studied the long-term outcome of transurethral puncture of ectopic 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 exclusion criteria were orthotopic, bilateral and prolapsing ureteroceles.
Results:
We identified 19 girls and 2 boys, of whom 11 presented with prenatal hydronephrosis and 10 presented with urinary tract infection. Mean age at puncture was 5 months (range 0.5 to 60). Preoperatively voiding cystourethrography revealed no reflux in 7 patients, isolated ipsilateral lower pole reflux in 8, and bilateral and/or contralateral reflux in 6. Postoperatively 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 developed 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 required in 15 of the 21 cases (71%), including ureterocele excision with ureteral 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 effective short-term correction of upper pole obstruction but it is not definitive therapy in the majority of cases. Most children still require open surgery. In patients without reflux after the puncture procedure new onset, recurrent 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.