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[Is one-stage ureterocele repair possible in children?]
Paul Sauvage1, François Becmeur, Raphaël Moog
1Service de Chirurgie Infantile, CHU Hautepierre, avenue Molière, 67098 Strasbourg. Paul.Sauvage@chru-strasbourg.fr
Insights
Ureterocele repair in children has a 64.2% cure rate with one-stage procedures. Distal incision is recommended first, followed by nephrectomy for infections, reserving intravesical approaches for pyelonephritis.
Area of Science:
- Pediatric Urology
- Congenital Malformations
- Surgical Outcomes
Context:
- Ureteroceles are rare, polymorphic congenital malformations requiring diverse treatment approaches.
- Assessing long-term outcomes of ureterocele repair is crucial due to treatment variability.
Purpose:
- To determine the long-term results of various ureterocele repair techniques in children.
- To evaluate the efficacy of different surgical strategies based on ureterocele anatomy and presentation.
Summary:
- A one-stage ureterocele repair achieved a cure rate of 64.2% in 126 children over a mean follow-up of 72 months.
- Success rates varied by anatomical type (single vs. double lumen) and implantation site (intravesical vs. ectopic).
- Distal incision showed promising results, with staged approaches recommended for recurrent infections or pyelonephritis.
Impact:
- Findings suggest a staged treatment approach for ureteroceles, prioritizing less invasive methods initially.
- Optimizing surgical strategies can improve outcomes and minimize risks, especially regarding sphincter damage in older patients.
Aim:
To determine the long-term results of ureterocele repair, bearing in mind the relative rarity of the malformation, its very polymorphic appearance and the diversity of treatments.
Material And Methods:
Long-term results were assessed by postoperative follow-up of 126 children with 131 ureteroceles between 1970-2000.
Results:
With a mean follow-up of 72 months, only 64.2% of children were cured after a one-stage procedure. According to the anatomical type, favourable results were obtained in 81.6% of cases with a single lumen and 57.9% of cases with a double lumen. Treatment success rates for single or double lumens were 73% in the case of intravesical implantation and only 53.9% (34/63 children) in ectopic forms. According to the technique, cure rates were 67.6% after distal incision in 34 children, 61.9% after total nephrectomy or superior pole nephrectomy in 42 children, 50% after ureterocele repair and ureterovesical reimplantation in 20 patients, 75% after total resection of the pathological lumen, parietal reconstruction and ipsilateral and/or contralateral reimplantation in another 20 patients.
Conclusions:
A one-stage procedure is only able to cure 2/3 of patients. In view of the tendency to progressive regression of often monstrous distensions during the neonatal period, first-line treatment should consist of a distal incision, followed, in the case of recurrent infections, by partial or total nephrectomy, while reserving the intravesical approach to cases with recurrent pyelonephritis. When this surgery is performed on older children or adolescents, the ureteroceles will be smaller with a lesser risk of sphincter damage.