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[Ureterocele. Tailored treatment. Report of 45 cases]
J Rodó Salas1, M Martí Camp, J M Mallol
1Servicio de Cirugía, Hospital San Juan de Dios, Barcelona, España.
Insights
This study reviewed 45 ureterocele cases, finding early diagnosis and varied surgical treatments improved outcomes. Most patients showed satisfactory results post-treatment, despite some developing pyelonephritic scars or residual reflux.
Area of Science:
- Urology
- Pediatric Surgery
Context:
- Ureteroceles, congenital urinary tract anomalies, are increasingly diagnosed early due to treatment advancements.
- This retrospective study analyzes a significant cohort of ureterocele cases treated over an 18-year period.
Purpose:
- To report on the diagnosis, surgical management, and outcomes of 45 ureterocele cases.
- To evaluate the effectiveness of various surgical interventions and identify associated complications.
Summary:
- The study included 43 pediatric patients with simple and ectopic ureteroceles, diagnosed via IVP and cystography, with some cases involving ureteropelvic duplications and reflux.
- Treatment strategies ranged from observation and endoscopic incision to extensive surgical procedures including resection, reimplantation, heminephrectomy, and nephrectomy.
- Post-treatment follow-up at 6 and 18 months indicated an 88.3% satisfactory outcome rate, though pyelonephritic scars, residual reflux, and urinary incontinence were noted complications.
Impact:
- Provides valuable data on the long-term outcomes of different ureterocele treatment modalities in a pediatric population.
- Highlights the importance of comprehensive pre- and post-operative evaluation, including imaging and functional assessments.
- Contributes to the understanding of ureterocele management and associated morbidities, informing clinical practice and future research.
Abstract:
The advancements in the treatment of ureterocele have prompted early diagnosis of this condition. We report on 45 cases of ureterocele (6 simple and 39 ectopic) that had been treated at our service from 1974 to 1992. The present series comprised 43 patients (32 females, 13 males), with ages ranging from 20 hours to 9 1/2 years; three cases had been diagnosed prenatally. All cases were evaluated by IVP and cystography. There were 16 cases of left ureteropelvic duplicity, 11 right and 10 bilateral. There was one case with right triplication and 6 cases with single system. Fourteen cases had reflux in the lower ipsilateral kidney, 5 in the contralateral kidney and 4 were bilateral. In some cases, patient evaluation included the use of isotopes, US, CT and cystography. Two cases required no surgical procedure; 2 required endoscopic incision; 6 resection and reimplantation; 1 heminephrectomy; 19 resection and heminephrectomy; 1 resection, reimplantation and ureteropyelostomy; 8 resection and nephrectomy; aspiration, nephrectomy and resection of the ureterocele was required in 1 case. Control evaluation at 6 and 18 months following treatment was satisfactory in 88.3%; of these, 41.8% had pyelonephritic scars, 16.2% had residual reflux and 4.6% urinary incontinence. There was only one death.