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Long-term bladder function after ureterocele decompression in children
Annabel Paye-Jaouen1, Filippo Pistolesi1, Nathalie Botto1
1Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Insights
Ureterocele decompression in childhood rarely causes long-term bladder dysfunction. Even with subsequent bladder surgery, significant issues are uncommon, ensuring good bladder function outcomes.
Area of Science:
- Pediatric Urology
- Urologic Oncology
Background:
- Duplex system ureteroceles are congenital anomalies requiring surgical intervention.
- Long-term bladder function following ureterocele surgery in children is not well-established.
Purpose of the Study:
- To assess long-term bladder function in children treated for duplex system ureteroceles.
- To compare functional outcomes based on surgical approach: ureterocele decompression versus bladder surgery.
Main Methods:
- A cohort of toilet-trained children treated for ureteroceles between 1990 and 2010 were evaluated.
- Voiding dysfunction was assessed using the Dysfunctional Voiding Symptom Score (DVSS) questionnaire and noninvasive studies (uroflowmetry, electromyography, post-void residual urine).
- Patients were categorized into Group 1 (ureterocele decompression) and Group 2 (primary/secondary bladder surgery).
Main Results:
- Forty-five patients with a mean follow-up of 9.5 years were analyzed.
- Group 1 (n=33) showed a mean DVSS of 1.5, with 22% exhibiting abnormal uroflowmetry or post-void residual urine.
- Group 2 (n=12) had a mean DVSS of 4, with 66% showing abnormal uroflowmetry or post-void residual urine (p=0.036). Only one child required intermittent catheterization.
Conclusions:
- Ureterocele decompression in early childhood is associated with favorable long-term bladder function.
- Secondary bladder surgery, when necessary, rarely results in significant long-term bladder dysfunction.
- Surgical management of duplex system ureteroceles generally preserves bladder function effectively.
Purpose:
There is limited knowledge of long-term bladder function after ureterocele decompression. We studied bladder function in patients who underwent surgery in childhood for duplex system ureteroceles.
Materials And Methods:
Toilet trained children treated for duplex system ureteroceles between 1990 and 2010 were included in study. We evaluated voiding dysfunction by the valid DVSS questionnaire and noninvasive studies, including uroflowmetry, electromyogram and post-void residual urine measurement. Urodynamics were done only in patients with abnormal DVSS or abnormal noninvasive studies. Patients were divided into group 1-ureterocele decompression (endoscopic incision), upper pole partial nephrectomy and ureteropelvic anastomosis, and group 2-primary or secondary bladder surgery (ureterocelectomy, ureterovesical reimplantation and bladder floor reconstruction).
Results:
Of 62 operated patients 17 were lost to followup and 45 were fully studied at a mean followup of 9.5 years (range 3 to 20). Initial surgery was done at mean age of 5.1 months (range 6 days to 48 months). In the 33 group 1 patients, of whom 70% underwent endoscopic incision, the mean DVSS score was 1.5 (range 0 to 6), 7 patients (22%) had abnormal uroflowmetry or significant post-void residual urine and none had abnormal DVSS results. In the 12 patients in group 2 the mean DVSS score was 4 (range 0 to 11), 8 patients (66%) had abnormal uroflowmetry and significant post-void residual urine, and 3 had abnormal DVSS findings (p = 0.036). All group 2 patients underwent bladder surgery after decompression, including endoscopic incision in 2 and upper pole partial nephrectomy in 1. Only 1 child needed clean intermittent catheterization at age 3 years for hypocontractile megacystis and repeat febrile urinary tract infections.
Conclusions:
Ureterocele decompression alone in early childhood does not lead to major bladder dysfunction at long-term evaluation. Even if secondary bladder surgery is needed, significant bladder dysfunction is rare.
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