Current Role of Simplified Upper Tract Approach in the Surgical Treatment of Ectopic Ureteroceles: A Single Centre’s Experience

Gomes, João Cavaco; Mendes, Mónica; Castro, Roberto De; Reis, Armando

doi:10.1016/s0302-2838(02)00042-8

Cited by 20 publications

(6 citation statements)

References 13 publications

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“…Consequently, it has been recommended that this pro cedure be limited to cases of preoperative multiple or highgrade vur. 2,9,11 attempts have been made to simplify total recon struction. Gran et al 31 proposed avoiding the upper tract approach and also reimplanting the ureter of 32 alternatively, uretero ureterostomy has been reported as a viable option, even in cases in which there is a marked discrepancy in diameter between the donor and recipi ent ureter.…”

Section: Results Of Management Optionsmentioning

confidence: 99%

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Management of duplex system ureteroceles in neonates and infants

Castagnetti

El-Ghoneimi

2009

Nat Rev Urol

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Ureteroceles associated with the upper pole of a complete ureteral duplication are known as duplex system ureteroceles (DSUs). A limited knowledge of the natural history of this condition makes its management in neonates and infants controversial. Asymptomatic neonates diagnosed antenatally in the absence of severe hydroureteronephrosis (HUN) are at low risk of developing urinary tract infections during the first months of life. These patients might, therefore, begin antibiotic prophylaxis and undergo comprehensive assessment by 3-6 months. Subsequently, conservative management can be viable in patients without severe HUN or high-grade vesicoureteral reflux (VUR). Cases of DSUs with severe HUN but no VUR can be treated by an upper urinary tract approach or by endoscopic decompression depending on upper pole function. Patients with preoperative VUR represent the most challenging cases. If VUR cure is considered necessary, lower urinary tract reconstruction is recommended. Endoscopic decompression allows for a definitive treatment in at least 50% of cases and, in the remaining cases, can be combined with conservative management or endoscopic treatment of VUR. Nonfunctioning or poorly functioning upper poles can be left in situ both in lower urinary tract reconstruction and after endoscopic decompression. Parental preferences should also be taken into account in the decision-making process.

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Section: Results Of Management Optionsmentioning

confidence: 99%

“…2,8 Flexible strategies have also been proposed, with approaches chosen depending on preoperative variables, such as ureterocele position (intravesical versus ectopic), and number of moieties with vesicoureteral reflux (vur) or nonrefluxing hydroureteronephrosis (Hun). [9][10][11] Finally, conservative…”

mentioning

confidence: 99%

Management of duplex system ureteroceles in neonates and infants

Castagnetti

El-Ghoneimi

2009

Nat Rev Urol

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“…Gomes et al [11] reported a success rate of 80% using the upper tract approach in ectopic ureteroceles without VUR Similarly, the need for secondary surgery in these patients without VUR has been found to be 15-20% [9,12] . Generally, upper pole nephrectomy was successful in cases of ectopic ureteroceles with no preoperative VUR.…”

Section: Discussionmentioning

confidence: 99%

Lower Urinary Tract Reconstruction in Ectopic Ureteroceles

Ziylan

Oktar²,

Korğalı³

et al. 2005

Urol Int

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Objectives: The management of ectopic ureteroceles is a challenging entity in pediatric urology. In our study, we aimed to determine the outcome after lower urinary tract reconstruction in ectopic ureteroceles. Materials and Methods: A total of 18 (12 girls, 6 boys) children with ectopic ureteroceles, treated between 1993 and 2003 by complete reconstruction, were enrolled in the study and their records were retrospectively reviewed. Results: Ureterocele was found to be unilateral in 16 and bilateral in 2 children. Four patients had been previously managed by endoscopic interventions and 1 patient underwent partial nephrectomy. Ureterocelectomy was performed on 20 renal units, and of these 20 renal units, 9 underwent heminephroureterectomy, 1 ureterectomy, and 3 (with single system ureteroceles) nephroureterectomy. Seven (35%) renal units with adequate function underwent ureteral reimplantations. After a mean follow-up of 5.4 years (range 4 months to 9.5 years), no patient required a second procedure. Contralateral reflux that developed in 2 children after surgical treatment resolved spontaneously after 1 year of follow-up. Conclusion: In the management of ectopic ureterocele, lower urinary tract reconstruction is an effective treatment alternative. According to the functional status of the renal parenchyma involved, the surgical procedure was limited to the lower urinary tract in 35% of the cases.

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“…Доказано, что при уретероцеле, не связанном с удвоением мочеточника, ТУРУ в большинстве случаев является окончательным методом лечения [7,10]. Однако во многих исследованиях было показано, что при уретероцеле, ассоциированном с полным удвоением мочеточника, эффективность эндоскопической процедуры значительно ниже в связи высокой вероятностью развития ПМР [7,8,15,18]. Также сообщалось, что частота повторных операций после ТУРУ, таких как иссечение уретероцеле с уретероцистоанастомозом и геминефрэктомия, значительно выше при удвоении мочеточника и составляет от 35 до 65 % [10,12,17,19].…”

Section: техника операцииunclassified

“…Исследования показали, что у многих пациентов эндоскопическая декомпрессия уретероцеле является первой и окончательной процедурой, а более инвазивные последующие операции должны выполняться только по строгим показаниям при наличии клинических проявлений заболевания, независимо от наличия ПМР и степени утраты функции почки [6]. Однако имеются и сторонники более инвазивного подхода для первичного лечения уретероцеле [8,9]. Он заключается в геминефрэктомии верхнего полюса почки или реимплантации мочеточника с удалением уретероцеле.…”

Section: Introductionunclassified

Effectiveness of endoscopic treatment of duplex system ureteroceles in children

Дубров¹,

Игоревич²,

Strotsky

et al. 2020

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Objective. The aim of this study is to evaluate the efficiency of transurethral incision of ureteroceles and incidence of vesicoureteral reflux in pediatric patients with duplex system ureterocele. Materials and methods. This is a retrospective study of 155 pediatric patients with duplex system ureterocele. The age of patients at the time of surgery ranged from 5 days to 17 years (median 8.0 months). Intravesical ureterocele had 108 patients (69.8%), extravesical 47 (30.2%). Results. Complications occurred in 2 patients (1.3%), recurrence obstruction was in 1 case (0.6%). Ipsilateral vesicoureteral reflux after surgery had 112 patients (72.3%): in the upper pole 51 cases (32.9%), in the lower pole 32 (20.6%), in both ureters 29 (18.7%). In the long-term period after transurethral incision of ureteroceles 97 patients (62.5%) needed reoperation due to infection and voiding dysfunction. Statistically significant risk factors associated with the need for reoperation were the presence of vesicoureteral reflux on the ureteroceles side and non-functioning upper pole of the kidney. Conclusion. Transurethral incision of ureteroceles for duplex system ureterocele is a safe and effective minimally invasive method of primary resolving of the obstruction. Vesicoureteral reflux on the ureterocele side after surgery had 72.3% of patients; reoperation in the long term was necessary in 62.5% cases. The main risk factor reoperation is vesicoureteral reflux on the ureterocele side.

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Current Role of Simplified Upper Tract Approach in the Surgical Treatment of Ectopic Ureteroceles: A Single Centre’s Experience

Cited by 20 publications

References 13 publications

Management of duplex system ureteroceles in neonates and infants

Management of duplex system ureteroceles in neonates and infants

Lower Urinary Tract Reconstruction in Ectopic Ureteroceles

Effectiveness of endoscopic treatment of duplex system ureteroceles in children

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