Ectopic ureterocele: long-term results of open surgical therapy in 54 patients
Aida Beganović1, Aart J Klijn, Pieter Dik
1Department of Pediatric Urology, University Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
Insights
Total reconstructive bladder surgery offers excellent long-term continence for children with ectopic ureteroceles. This approach leads to a low rate of urinary tract infections and fewer reoperations compared to endoscopic procedures.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Urology
Background:
- Ectopic ureteroceles can lead to significant urinary tract issues in children.
- Initial treatment strategies vary, impacting long-term outcomes.
Purpose of the Study:
- To assess the long-term results of total reconstructive bladder surgery as an initial treatment for ectopic ureteroceles.
- To evaluate continence and urinary tract infection rates post-surgery.
Main Methods:
- A cohort of 54 children with ectopic ureteroceles underwent total upper and lower urinary tract reconstructive surgery between 1988 and 2003.
- Long-term follow-up focused on continence and urinary tract infection rates.
Main Results:
- 94% of patients achieved continence.
- 17% experienced 1-2 uncomplicated urinary tract infections in the last two years.
- Low rates of persistent reflux (7 patients) and obstructive voiding (7 patients) were managed conservatively or with biofeedback.
Conclusions:
- Total reconstructive bladder surgery provides durable continence and minimal lower urinary tract symptoms in the long term for ectopic ureteroceles.
- This surgical approach demonstrates a lower reoperation rate compared to initial endoscopic interventions.
- Total reconstructive surgery is recommended as the primary treatment for ectopic ureteroceles.
Purpose:
We assessed the long-term results of total reconstructive bladder surgery as initial treatment of ectopic ureteroceles.
Materials And Methods:
Long-term followup was evaluated in 54 children treated for ectopic ureteroceles with total upper and lower urinary tract reconstructive surgery between 1988 and 2003, with special focus on the primary outcome factors continence and urinary tract infections.
Results:
Patient age at surgery was 0 to 8.8 years old (median 1.0), including 34 patients younger than 1 year. Followup was 2.3 to 15.6 years (median 9.6). Of the patients 94% became continent. During the last 2 years 17% of the patients experienced 1 or 2 uncomplicated episodes of urinary tract infection. One of the patients with incontinence received chemoprophylaxis due to frequent urinary tract infections. Secondary endoscopic procedures were necessary in 10 patients due to persistent reflux, and in 7 patients due to obstructive voiding. Reflux was present preoperatively in 33 patients, and low grade reflux was present postoperatively in 7, all of whom were treated conservatively. A total of 11 children presenting with dysfunctional voiding will be or have been trained in biofeedback.
Conclusions:
The vast majority of patients treated with total reconstructive bladder surgery become continent and do not suffer from lower urinary tract symptoms during the long term. The reoperation rate is low compared to series beginning with endoscopic surgery. Based on the results of this study, we suggest that total reconstructive upper and lower urinary tract surgery be the treatment of choice for ectopic ureteroceles.
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