Related Experiment Videos
Endoscopic incision of ureteroceles: intravesical versus ectopic
B Blyth1, G Passerini-Glazel, C Camuffo
1Department of Pediatric Urology, Children's Hospital of Philadelphia, University of Pennsylvania.
Insights
Endoscopic incision is an effective primary treatment for pediatric ureteroceles, often avoiding further surgery. This minimally invasive approach shows high success rates, particularly for intravesical ureteroceles, preserving kidney function.
Area of Science:
- Pediatric Urology
- Endourology
Background:
- Ureteroceles are congenital anomalies of the ureter.
- Management strategies for pediatric ureteroceles vary, impacting renal function and requiring surgical intervention.
Purpose of the Study:
- To evaluate the efficacy of endoscopic incision as a primary treatment for pediatric ureteroceles.
- To compare outcomes between intravesical and ectopic ureteroceles treated with endoscopic incision.
Main Methods:
- Retrospective review of 51 children undergoing endoscopic incision for ureteroceles.
- Analysis of success rates, need for secondary surgery, and development of vesicoureteral reflux.
- Comparison of outcomes based on ureterocele location (intravesical vs. ectopic).
Main Results:
- 73% of patients required no further surgery after primary endoscopic incision.
- Intravesical ureteroceles had significantly better upper pole function preservation (96%) and lower secondary surgery rates (7%) compared to ectopic ureteroceles (50% function preservation, 50% secondary surgery).
- Reflux was created in 18% of intravesical cases and 47% of ectopic cases.
Conclusions:
- Endoscopic incision is a successful primary treatment for pediatric ureteroceles, especially intravesical types.
- The technique offers good outcomes and may reduce the need for more extensive procedures like partial nephroureterectomy.
- Careful consideration of ureterocele location is crucial for predicting outcomes and managing potential complications.
Abstract:
A total of 51 children, mostly less than 2 years old, underwent endoscopic incision of ureteroceles as a primary form of treatment. In 73% no further surgery was required. Of the patients 19 were diagnosed by prenatal ultrasound, with a urinary tract infection the usual presenting symptom in the remainder. Of 27 intravesical cases endoscopic incision resulted in decompression of the ureterocele in 93%, with preservation of upper pole function in 96%, and secondary surgical procedures were required in 7%. Reflux was created in 18% and it persisted in 2 of 4 patients. Of 24 cases of ectopic (extravesical) ureteroceles incision resulted in decompression in 75%, with upper pole function preserved in 50%. Reflux was created in 47% and a secondary surgical procedure was performed in 50%. Preservation of upper pole function was significantly better for intravesical versus ectopic ureteroceles (p < 0.01), and the requirement for secondary surgical procedure was greater with ectopic ureteroceles (p < 0.01). Three patients had intermittent bladder outlet obstruction following the incision and required further surgery. The 2 different techniques for incision of intravesical and ectopic ureteroceles are described. The role of endoscopic incision in the overall management of ureteroceles is confirmed by this review, and the need for partial nephroureterectomy may diminish.