[Ureterocele associated to duplex system: an individualized approach to endoscopic incision]

Management of Ureterocele (UC) associated to duplex kidney depends from the type of UC (ectopic or intravesical), from the presence of symptoms and from associated vesicoureteral reflux (VUR) in the lower pole of the duplex system. Individualized approach to UC must consider endoscopic puncture as a possible option to reduce hydronephrosis and preserve function.

The records of 68 patients with duplex system have been reviewed. UC was detected in 27 renal units: it was intravesical in 11 and ectopic in 16. VUR was present in the lower pole in 16 cases. Patients were observed between 1991 and 2001 and mean follow up lasted 20 months (range 2-70). Endoscopic incision was performed in 21 patients. Upper pole nephrectomy, intravesical reconstruction or simple observation were decided for six patients.

Endoscopic incision was effective in the treatment of intravesical UC and in some cases, without VUR in the lower pole, it was the unique procedure. Among ectopic UC, a secondary VUR developed following endoscopic incision in 43% of cases and required further treatment. Renogram did not show any significant functional improvement in the affected renal pole, secondary to endoscopic treatment. An open antireflux procedure was necessary in cases with associated VUR.

Total or partial nephrectomy were performed among the first cases of the present series and in most of them it required a double step operation (abdominal and intravesical). In few cases of uncomplicated UC with a non functioning upper pole, a conservative approach was followed by spontaneous reduction of dilatation.