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Surgical management of infantile (ectopic) ureteroceles: report of a modified approach
Insights
Management of infantile ureteroceles requires individualized strategies. A two-stage endoscopic incision followed by surgical correction is preferred, reducing operative time and blood loss in pediatric patients.
Area of Science:
- Pediatric Urology
- Surgical Management
- Congenital Anomalies
Background:
- Infantile (ectopic) ureteroceles present complex management challenges.
- No single surgical procedure is universally applicable for all cases.
- Previous management strategies involved lengthy procedures with significant blood loss.
Purpose of the Study:
- To review institutional experience with infantile ureteroceles.
- To evaluate the efficacy of a two-stage management approach.
- To identify principles guiding surgical strategy.
Main Methods:
- Retrospective review of 22 patients (24 renal units) managed since 1970.
- Analysis of surgical outcomes, including reoperations and complications.
- Implementation and evaluation of a two-stage endoscopic incision followed by surgical correction in the last 4 patients.
Main Results:
- Upper pole moiety preservation is successful with functioning parenchyma.
- Total ureterectomy-ureterocelectomy is not consistently necessary.
- Urinary tract infections are common postoperatively, especially with double barrel reimplantations.
- The two-stage procedure demonstrated reduced operative time and blood loss.
Conclusions:
- Management of infantile ureteroceles should be tailored to individual patient factors.
- A two-stage approach involving initial endoscopic incision is a promising method.
- This technique may be particularly beneficial for very young or compromised pediatric patients.
Abstract:
Since 1970, our experience in managing 22 patients (24 renal units) with infantile (ectopic) ureteroceles suggests that no single procedure is universally applicable. Certain general principles, however, guide management strategy. First, preservation of the upper pole moiety is successful if there is functioning renal parenchyma on IVP (9 cases with one failure). Second, when extirpation is required, total ureterectomy-ureterocelectomy is unnecessary (13 cases with no reoperations specifically for stump extirpation). Third, urinary tract infections are fairly common in the first postoperative year (4 of 16 patients), being more common in children with common sheath ("double barrel") reimplantations. This review of our experience often showed the primary procedure to be long and difficult with significant blood loss. Although it did not occur in this series, devascularization of the lower pole ureter remains a danger. Therefore, a two-stage procedure was developed to obviate these problems. In the last 4 patients (5 renal units) in this series, the ureteroceles were first incised endoscopically. Six weeks later, reimplantation or upper pole nephrectomy-partial ureterectomy was performed. Adequate early decompression of the ureterocele resulted in less operative time and blood loss (average 27.5 cc for upper pole nephrectomy) at the subsequent procedure. We now prefer this method, especially in very young or compromised patients, although the follow-up time is inadequate to recommend it generally.