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[Treatment of pyeloureteral duplication associated with ureterocele or ectopic ureter]
I Somoza Argibay1, R Méndez Gallart, M Gómez Tellado
1Servicio de Cirugía Pediátrica, Hospital Materno Infantil Teresa Herrera, Complejo Hospitalario Juan Canalejo, A Coruña.
Introduction:
Pyeloureteral duplication is often associated to ureterocele and ectopic ureter. Therapeutic approach of ureterocele is actually a debated subject because of the differences treatments. There is controversy about the classic heminefrectomy with ureterocele aspiration and the minimal invasive endoscopic approach.
Material And Methods:
We made a retrospective study about 34 children with pyeloureteral duplication associated with ureterocele (26) or with ectopic ureter (8). The election of treatment was mainly based on renal function, showed on gammagraphy. It was performed heminephrectomy and ureterocele aspiration in patients with hypofunctioning upperpole, and surgery saving the kidney when the renal function was normal.
Results:
Heminephrectomy was curative in 66.5% of children with ureterocele. In the others was required a correction of the vesicoureteral reflux associated with the lower pole or removal of the ureterocele with ureteral reimplantation due to failure in ureterocele collapse. 88.5% of ureterocele was collapsed. None of the heminefrectomies performed on patients with ectopic ureter needed further surgery. Pathology studies showed a high incidence of renal dysplasia (63%).
Conclusion:
We consider the heminephrectomy the treatment of choice in pyeloureteral duplication associated with ureterocele and ectopic ureter when gammagraphy studies show hypofunctioning upperpole.