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[Our experience with aspiration of ectopic ureteroceles]
E País Piñeiro1, D Vela Nieto, J Candal Alonso
1Servicio de Cirugía Infantil, Hospital Materno-Infantil, La Coruña.
Insights
Suction of ectopic ureteroceles can avoid bladder surgery in 60% of cases. Close follow-up is crucial to monitor for ureterocele collapse and potential complications.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Renal Health
Background:
- Ectopic ureteroceles can cause significant obstruction in pediatric kidneys.
- These obstructions may affect single or multiple renal moieties, leading to potential kidney damage.
- Associated conditions like vesicoureteral reflux and renal duplication are common.
Purpose of the Study:
- To evaluate the efficacy of suction as a primary treatment for ectopic ureteroceles.
- To assess the outcomes and complications associated with ureterocele suction.
- To determine the potential to avoid more invasive bladder surgery.
Main Methods:
- Retrospective analysis of seven pediatric cases undergoing ectopic ureterocele suction since 1986.
- Various surgical approaches including heminephrectomy, nephrectomy, and ureteropyelostomy were employed alongside suction.
- Renal function was assessed using Technetium-99m dimercaptosuccinic acid scans (DMSA) when necessary.
Main Results:
- Ureterocele collapse and good renal outcomes were observed in five out of seven children.
- Two cases required ureterocele excision due to lack of collapse, with one experiencing persistent renal dilatation.
- One nephrectomy was performed due to non-recuperation of renal function.
- Associated reflux resolved in one of three affected children post-suction.
Conclusions:
- Suction of ectopic ureteroceles is a viable technique that can potentially obviate the need for bladder surgery in approximately 60% of cases.
- Careful and consistent long-term follow-up is essential to detect ureterocele collapse failures.
- While effective, complications such as persistent dilatation or the need for nephrectomy can occur.
Abstract:
Since 1986 we have performed suction of the ectopic ureteroceles in seven cases. In four of these cases the obstruction caused by the ureteroceles affected the upper hemi-kidney. In the remaining three cases both hemi-kidneys of the same side were affected. One child suffered failure of both hemi-kidneys. All the ureteroceles corresponded to the upper hemi-kidney and were associated with ipsilateral duplicity. In four of the cases the treatment applied was the heminephrectomy of the upper hemi-kidney and the suction of the ureterocele. In one case, we did a nephrectomy and suction of the ureterocele. In the remaining two cases the suction of the ureterocele was done, as well as the ureteropyelostomy, since it was necessary to use the upper hemi-kidney in the renal TC99m dimercaptosuccinic acid scan-DMSA. In five of the children there was a collapse of the ureterocele giving good results in both kidneys. In two of the children there was no collapse, which provoked the need for removal of the ureterocele. In one of these two cases, the renal dilatation persisted later. In the last case it was necessary to perform nephrectomy due to the absence of recuperation of the renal function. Three of the children had associated reflux which disappeared in one of them, after the suction of the ureterocele. Vesical surgery might be avoided by means of the ureterocele's suction technique in 60 per 100 of the cases. However, it is essential to pursue the child's progress once every six months, in order to detect possible failures of ureterocele collapse.