Management and outcomes of ureteroceles in children: An experience of 25 years
Vishesh Jain1, Sandeep Agarwala1, Anjan Dhua1
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Insights
Duplex system ureteroceles often require repeat procedures after initial endoscopic treatment. Ectopic ureteroceles are more frequently associated with the need for nephrectomy.
Area of Science:
- Pediatric Urology
- Urogenital Malformations
- Surgical Outcomes
Background:
- Ureterocele is a rare congenital anomaly of the urinary tract.
- Treatment strategies for ureterocele are varied and depend on anatomical and clinical factors.
- Understanding outcomes is crucial for optimizing pediatric ureterocele management.
Purpose of the Study:
- To evaluate the management and outcomes of pediatric ureterocele cases.
- To compare outcomes between single system and duplex system ureteroceles.
- To identify factors influencing the need for further surgical intervention.
Main Methods:
- Retrospective analysis of pediatric patients with ureterocele operated between 1992 and 2018.
- Assessment of case records to document management and surgical procedures.
- Evaluation of symptom persistence and requirement for secondary surgeries as outcome parameters.
Main Results:
- A total of 47 patients (51 renal units) were analyzed.
- Duplex system ureteroceles (31 units) had a 40% rate of requiring a second procedure after cystoscopic decompression.
- Single system ureteroceles (20 units) had a 7% rate of requiring a second procedure (P = 0.024).
- Ectopic ureteroceles (16 units) had a 56% rate of nephrectomy/heminephrectomy, versus 5.7% for intravesical ureteroceles (P < 0.001).
Conclusions:
- Duplex system ureteroceles demonstrate a higher likelihood of requiring repeat endoscopic procedures.
- Ectopic ureteroceles are significantly more prone to necessitate nephrectomy or heminephrectomy.
- Management strategies should consider ureterocele type and location to predict surgical outcomes.
Introduction:
Ureterocele is a rare urogenital malformation. The treatment is variable and complicated as it depends on several factors. The aim of this study was to evaluate the management and outcomes of children with ureterocele and to compare single system and duplex system ureteroceles.
Materials And Methods:
A retrospective study was conducted and all patients with ureterocele operated from January 1992 to December 2018 were included. The records of those included were assessed, and a detailed case record sheet was filled. The outcome parameters assessed were the persistence of symptoms and additional surgical procedure performed.
Results:
Forty-seven patients (28 boys and 19 girls) with a median age of presentation of 21 months were included. Four patients had bilateral ureterocele. Overall, 51 renal units with ureterocele were studied. Twenty renal units of the 31 renal units with duplex system underwent cystoscopic decompression, and of these, 8 (40%) needed a second procedure. Fourteen renal units of the remaining 20 renal units with single system underwent cystoscopy and decompression, and of these, 1 (7%) required another procedure (P = 0.024). Sixteen renal units had ectopic ureterocele, of which 9 (56%) underwent heminephrectomy/nephrectomy. Intravesical ureterocele was present in 35 renal units, of which only 2 (5.7%) underwent nephrectomy or heminephrectomy (P < 0.001).
Conclusion:
Duplex system ureteroceles are more likely to require a second procedure following an endoscopic puncture. Units with ectopic ureterocele were more likely to need nephrectomy.
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