Related Experiment Videos
Endoscopic management of ureteroceles in children
1Department of Pediatric Surgery, University Hospital of Lausanne (CHUV), Switzerland.
Insights
Endoscopic incision effectively treats pediatric ureteroceles, resolving upper urinary tract dilation. While successful for intravesical types, ectopic ureteroceles may require additional surgery.
Area of Science:
- Pediatric Urology
- Minimally Invasive Surgery
- Endourology
Background:
- Ureteroceles in children present diverse forms, necessitating varied treatment approaches.
- Endoscopic management offers a minimally invasive option for ureterocele treatment.
Purpose of the Study:
- To evaluate the efficacy of endoscopic management for pediatric ureteroceles.
- To compare outcomes between intravesical and ectopic ureteroceles treated endoscopically.
Main Methods:
- A retrospective review of 11 ureteroceles in 10 children treated via endoscopic incision between 1987 and 1993.
- Procedure involved a small incision at the lower and median aspects of the ureterocele.
Main Results:
- Complete resolution or reduction of upper urinary tract dilation observed in all intravesical ureteroceles and 50% of ectopic ureteroceles.
- Vesicoureteral reflux occurred in 54.5% of cases post-procedure.
- 5-year follow-up showed 71.5% of intravesical ureteroceles required no further surgery, versus 0% for ectopic types.
Conclusions:
- Endoscopic incision is a safe and effective initial treatment for pediatric ureteroceles, improving upper tract dilation and renal function.
- Intravesical ureteroceles demonstrate better outcomes with endoscopic management alone compared to ectopic ureteroceles.
- Endoscopic treatment can obviate the need for further surgical intervention in select cases, particularly in neonates.
Objective:
Treatment of ureteroceles in children varies according to the anatomicopathological form and the choice of the surgical team. This study tries to determine the exact value of the endoscopic management of ureteroceles in children.
Methods:
Between 1987 and 1993, 11 ureteroceles in 10 children were treated by endoscopic incision: 7 intravesical ureteroceles (4 single system and 3 duplex system) and 4 duplex-system ectopic ureteroceles. The procedure consists of a tiny transversal incision at the lower and median aspects of the ureterocele.
Results:
The dilation of the upper urinary tract disappeared or decreased in all cases of intravesical ureteroceles and in half the cases of ectopic ureteroceles. Endoscopic incision of the ureterocele led to a vesicoureteral reflux in the associated ureter in 6 cases: 54.5% (43% of the intravesical ureteroceles, 75% of the ectopic ureteroceles). Following endoscopic treatment, no further surgery was required in 5 of the 7 cases with intravesical ureteroceles (71.5%), while every case of ectopic ureterocele needed a further operation (lower tract surgery in 3 cases, upper tract surgery in 1 case).
Conclusions:
Endoscopic incision of ureteroceles is a simple and quick procedure which allows obstruction to be removed and the dilation of the upper urinary tract and its corresponding kidney function to be improved, particularly in the neonate. The endoscopic management of ureteroceles may in itself suffice, without necessity of further surgery. These favorable results can more readily be seen in cases of intravesical ureterocele than in those of ectopic ureterocele.