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[Endoscopic treatment of prenatally diagnosed ureteroceles]
1Clinique chirurgicale infantile, Hôpital Charles Nicolle, Rouen, France.
Insights
Neonatal endoscopic incision effectively treats antenatally diagnosed ureteroceles by decompressing the ureterocele. However, secondary vesicoureteric reflux requires further management in some cases, necessitating careful radiological surveillance.
Area of Science:
- Pediatric Urology
- Endourology
- Congenital Abnormalities
Background:
- Reports on 16 infants with antenatally diagnosed ureteroceles.
- Immediate neonatal endoscopic incision was used for treatment.
- Objective was effective ureteral decompression.
Purpose of the Study:
- To evaluate the efficacy of immediate endoscopic incision for antenatally diagnosed ureteroceles.
- To assess complications and need for further intervention.
Main Methods:
- 17 ureteroceles (7 intravesical, 10 ectopic) assessed postnatally.
- Endoscopic incision performed for all cases.
- Follow-up for renal function and vesicoureteric reflux.
Main Results:
- Endoscopic opening successfully collapsed all ureteroceles.
- Renal function generally improved post-procedure.
- Secondary vesicoureteric reflux occurred in 7 ectopic cases, requiring further surgery.
- One case of ectopic ureterocele needed ureteronephrectomy due to non-function.
Conclusions:
- Early endoscopic incision is a viable first-line treatment for antenatal ureteroceles.
- Secondary vesicoureteric reflux is the primary complication.
- Essential to implement radiological surveillance post-treatment.
Introduction:
The authors report a series of 16 infants presenting with an antenatally diagnosed ureterocele, treated immediately, during the neonatal period, by endoscopic incision. The objective of this treatment is to ensure effective decompression of the ureterocele.
Material And Methods:
The immediate postnatal assessment revealed 17 ureteroceles, including 7 intravesical ureteroceles (with one bilateral form) and 10 ectopic ureteroceles. Endoscopic opening allowed collapse of all of the ureteroceles and usually ensured improvement of renal function. Vesicoureteric reflux was observed secondarily in 7 infants with an ectopic form of the disease, and was present primarily in two other patients.
Results:
In patients with an intravesical form, endoscopic treatment was found to be effective on its own and no complementary procedure was required. In contrast, in ectopic forms, a second operation was required in 9 cases: presence of vesicoureteric reflux (8 cases) required resection of the ureterocele with vesical reconstruction and ureteric reimplantation according to Cohen's technique. In one case, total ureteronephrectomy was performed due to complete absence of function of the kidney concerned.
Conclusion:
Endoscopic opening, performed soon after birth, can be considered to be the first-line treatment of antenatally diagnosed ureteroceles. Its main complication remains the secondary development of vesicoureteric reflux Radiological surveillance therefore appears to be essential.