Transurethral incision of ureteroceles in paediatric age group
Hemanshi Shah1, Charu Tiwari1, Neha Sisodiya Shenoy1
1TNMC & BYL Nair Hospital, Mumbai, Maharashtra, India.
Insights
Transurethral incision is a valuable primary treatment for pediatric ureteroceles, often proving sufficient as the sole intervention. Regular follow-up is crucial for successful management of these challenging urinary tract anomalies.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Urogenital Anomalies
Background:
- Ureteroceles present significant clinical challenges due to anatomical variations and diverse presentations.
- Management strategies for pediatric ureteroceles require careful consideration of individual patient factors.
Purpose of the Study:
- To evaluate the efficacy and outcomes of primary transurethral incision for treating ureteroceles in pediatric patients.
- To assess the role of minimally invasive cystoscopic incision as a primary intervention.
Main Methods:
- Retrospective analysis of 13 children diagnosed with ureteroceles between 2009 and 2016.
- Data collected included patient demographics, clinical presentation, uretocele characteristics, investigations, surgical management (transurethral incision), and follow-up outcomes.
Main Results:
- Thirteen pediatric patients (7 male, 6 female) underwent transurethral incision for ureteroceles.
- Common presentations included antenatal diagnosis (neonates), urinary tract infections, and abdominal pain.
- Associated findings included duplex systems, solitary kidneys, hydronephrosis, and hydroureter; two patients required subsequent ureteric reimplantation.
Conclusions:
- Primary transurethral incision is a valuable and often sufficient initial treatment for pediatric ureteroceles.
- Individualized management approaches are essential, but minimally invasive cystoscopic incision should be considered a primary intervention with diligent follow-up.
Objective:
Ureteroceles are a great clinical challenge because of variations in anatomy and clinical presentations. We present our experience with primary transurethral incision of ureteroceles in children.
Material And Methods:
Data of thirteen children managed for ureterocele from 2009 to 2016 was retrospectively analyzed with respect to age, sex, clinical presentation and symptomatology, type and localization of ureterocele, investigations, surgical management and follow-up.
Results:
A total of 13 patients with ureteroceles were managed. There were 7 males and 6 females. Six were neonates with antenatal diagnosis of ureteroceles. Five patients presented with urinary tract infection and two were diagnosed during ultrasound for abdominal pain. The ureteroceles were on the right side in 7 patients and left in 6 patients. Six patients had a duplex system-five on right side and bilateral in one. Two patients had ureteroceles in solitary kidney. Four patients had associated hydronephrosis and hydroureter and two had only hydronephrosis alone. One patient had bilateral grade III reflux in the bilateral lower moieties of the patient with bilateral duplex system. Two patients had poorly functioning kidney on radionuclide scan. All patients underwent cystoscopic incision of the ureteroceles. Eleven had intravesical ureteroceles and two had large caeco-ureteroceles. Two patients required ureteric reimplantation during follow-up.
Conclusion:
Though the approach of managing a patient with ureterocele should be individualized, transurethral incision remains valuable as a primary intervention with regular follow up. It may even prove to be the only intervention required in most of the patients.
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