Long-term Management of Ureterocele in Duplex Collecting Systems: Reconstruction Implications

Significant variance exists in the management of duplex collecting system ureteroceles (DSU). There is a great spectrum in classification, management, and surgical interventions. The practice of performing bladder level operations for vesicoureteral reflux (VUR) and trigonal anatomic distortion, either after ureterocele puncture or in a single setting, has come into question as to whether all DSU patients require it. In this review, we sought to discuss DSU management trends and the need for bladder reconstruction in these patients, as well as to describe our institution's practices.

Recent advances regarding DSU management revolve around differing surgical approaches, although adequately powered randomized control trials are lacking. These approaches include nonoperative management, various forms of endoscopic puncture, ureteroureterostomy, and most recently upper pole ureteral ligation. A common theme appears to reflect the acceptance that "less is more" when it comes to managing DSU. There is no consensus for the decision to treat or the surgical approach of DSU. Ureteral reimplantation and bladder neck reconstruction appears to be unnecessary in a significant portion of the DSU population, but ureterocele treatment needs to be individualized. There is an ongoing need for large, multi-institutional randomized control trials to evaluate this further.