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Published on: June 21, 2024
Evaluation of Pediatric Patients with a Diagnosis of Ureterocele
Özgür Özdemir Şimşek1, Sibel Tiryaki2, Gökçen Erfidan1
1Department of Pediatric Nephrology, Faculty of Medicine Tepecik Training and Research Hospital, University of Health Sciences, Izmir 35170, Turkey.
Insights
This study found no clear criteria for using voiding cystourethrography in children with ureterocele. Vesicoureteric reflux (VUR) did not correlate with increased kidney damage in these patients.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Ureteroceles are congenital anomalies that can lead to urinary tract infections (UTIs) and vesicoureteric reflux (VUR).
- The clinical significance of VUR in patients with ureteroceles, particularly those with a double collecting system, remains unclear.
- The role of voiding cystourethrography (VCUG) in managing ureteroceles is not well-defined.
Purpose of the Study:
- To evaluate the incidence of UTIs and VUR in pediatric patients diagnosed with ureterocele.
- To investigate the association between VUR and clinical outcomes such as kidney damage and need for surgery.
- To assess the utility of VCUG in the management of ureterocele.
Main Methods:
- Retrospective evaluation of pediatric patients diagnosed with ureterocele between 2012 and 2022.
- Data collected included demographic, clinical, and laboratory findings, focusing on UTI history and VUR.
- Analysis of VCUG findings in relation to clinical presentation and outcomes.
Main Results:
- Twenty-four children with ureterocele were included; 54.2% presented with antenatal hydronephrosis and 37.5% with UTI.
- VUR was present in 11 patients (45.8%), with severe VUR (≥stage 3) in 9 (37.5%).
- VUR was associated with female gender and UTI history, but not with ipsilateral hydronephrosis, renal scarring, or surgical intervention.
Conclusions:
- No specific criteria were identified to guide the selection of patients with ureterocele for VCUG.
- VUR did not appear to cause additional kidney damage in this cohort.
- Further research is needed to establish optimal management strategies for pediatric ureterocele cases.
Abstract:
Aim: The presence and clinical importance of vesicoureteric reflux in patients with a double collecting system are being questioned. Therefore, the role of voiding cystourethrography in the management of patients with ureterocele is unclear. This study aimed to evaluate patients with a ureterocele in terms of urinary tract infection (UTI) and vesicoureteral reflux (VUR). Material Methods: The cases who were admitted to the Pediatric Nephrology Clinic of Health Sciences University Tepecik Training and Research Hospital between 2012 and 2022 and were diagnosed with ureterocele were evaluated retrospectively. Demographic, clinical, and laboratory data were obtained from file records. Results: All patients diagnosed with ureterocele and voiding cystourethrography (VCUG) were evaluated. A total of 24 (female 13 (54.2%)) children were included. The reasons for admission were antenatal hydronephrosis in 13 (54.2%) patients, UTI in 9 (37.5%) patients, and incidentally diagnosed ureterocele in 2 (8.3%) patients. Urinary tract infection was observed in 20 patients at admission, recurrent UTI in 21 patients at follow-up, preoperative pyelonephritis in 12 patients. VUR was found in 11 patients, and severe VUR (≥stage 3) was found in 9 patients. Ten patients had ipsilateral hydronephrosis, and 14 patients had a double collecting system. The presence of VUR was found to be associated with female gender, UTI at admission, and recurrent UTI at follow-up (p < 0.05). However, there was no difference between groups with or without VUR in terms of ipsilateral hydronephrosis, scar formation, and the need for surgery (p > 0.05). Conclusions: We could not demonstrate any criteria to select patients to receive VCUG; on the other hand, VUR did not cause more kidney damage. Our study supports the need for more scientific data to determine management in patients with ureterocele.
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