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This study analyzes ureteroceles in children, finding ureteric reimplantation preferable to nephroureterectomy due to frequent bilateral disease and associated malformations, despite potential postoperative reflux.
Area of Science:
- Pediatric Urology
- Surgical Management of Ureteroceles
- Congenital Urological Abnormalities
Background:
- Ureteroceles are congenital outpouchings of the ureter into the bladder.
- They are often associated with duplex collecting systems and other urological malformations.
- Management strategies vary, impacting long-term outcomes.
Purpose of the Study:
- To analyze the clinical and radiological features of ureteroceles in a pediatric cohort.
- To evaluate the outcomes of different surgical management techniques for ureteroceles.
- To determine the optimal surgical approach considering associated anomalies and potential complications.
Main Methods:
- Retrospective analysis of 26 children with ureteroceles.
- Surgical interventions included ureterocele resection with en bloc ureteral reimplantation, nephroureterectomy, and combined procedures.
- Clinical data and radiological findings were reviewed.
Main Results:
- Ureteroceles were associated with unilateral (23 cases) and bilateral (3 cases) double collecting systems.
- En bloc ureteral reimplantation was performed in 14 children, with 5 experiencing postoperative vesicoureteral reflux.
- Nephroureterectomy was performed in 11 cases, and 4 cases underwent nephroureterectomy.
Conclusions:
- Ureteric reimplantation is preferred over primary nephroureterectomy for ureteroceles, especially in cases of bilateral disease or associated malformations.
- Careful surgical planning is essential to minimize complications like postoperative reflux.
- Early intervention and appropriate surgical technique are crucial for favorable outcomes in pediatric ureterocele management.
Abstract:
Twenty-six children with ureteroceles--twenty-three with unilateral double collecting system and three with bilateral double kidney--are analyzed. The clinical and radiological features of these ureteroceles are presented. The different possibilities of surgical management and their results are discussed. In 14 of these children we performed resection of the ureterocele with en bloc reimplantation of both ureters. Eleven cases were treated by resection of the ureterocele and upper pole nephroureterectomy and four cases by nephroureterectomy. Vesicoureteral reflux in both renal pelvic moieties was found in five cases after ureteral reimplantation en bloc. Because of frequent bilateral disease (10%) and the common association of other urological malformation it is preferable to try to perform ureteric reimplantation rather than primary nephroureterectomy even when the possibility of postoperative reflux is considered.