Management of Ectopic Ureterocele Associated With Renal Duplication: A Comparison of Partial Nephrectomy and Endoscopic Decompression

Husmann, Douglas A.; STRAND, BILL; Ewalt, David H.; Clement, Michele R.; Kramer, Steve; Allen, Terry D.

doi:10.1097/00005392-199910000-00066

Cited by 8 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…many series have assessed the effectiveness of decompres sion in relation to ureterocele position: it seems to be the approach of choice for intravesical Dsus, 5,42 whereas it comprises the definitive treatment for about half of ectopic ureteroceles. 3,7 technical reasons might partly explain the different success rates.…”

Section: Results Of Management Optionsmentioning

confidence: 99%

“…3,7 technical reasons might partly explain the different success rates. according to current consensus, the best technique involves making an incision or puncture in the intra vesical portion of the ureterocele, just above the level of the bladder wall, 1,5,7,33,34,42 to create a valve mechanism that prevents the development of vur in the punc tured moiety. opening of the extravesical portion of the ureterocele is no longer recommended, as it only increases the risk of de novo reflux in the punctured moiety.…”

Section: Results Of Management Optionsmentioning

confidence: 99%

“…upper tract surgery the upper tract approach includes pyelopyelostomy in cases where the upper tract is functional or hemi nephrectomy in the case of nonfunctioning or poorly functioning upper moieties (which comprise ~70% of cases). 3,4,18,29 Hussmann et al 20,42 showed that in patients with ectopic Dsus and no preoperative vur, upper urinary tract surgery was significantly more effective than endoscopic decompression, and had an 80% chance of being the definitive treatment. it should be noted, however, that longterm followup studies reported a prevalence of de novo ipsilateral lower pole or contra lateral reflux of 40-50% following upper tract surgery.…”

Section: Results Of Management Optionsmentioning

confidence: 99%

“…owing to the lack of controlled trials, the limited number of case-control studies comparing different approaches, 17,36,42 and the limited knowledge of the natural history of the condition, an evidencebased choice of the initial management of Dsu in neonates and infants is currently not possible. this review shows that some of the classical arguments on which the choice of initial approach is usually based upon are indeed question able, including the need for systematic ureterocele decompression to prevent utis 17 or improve renal function, [23][24][25] and the need for systematic bladder base/neck reconstruction to prevent incontinence.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Management of duplex system ureteroceles in neonates and infants

Castagnetti

El-Ghoneimi

2009

Nat Rev Urol

View full text Add to dashboard Cite

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.

show abstract

Section: Results Of Management Optionsmentioning

confidence: 99%

Section: Results Of Management Optionsmentioning

confidence: 99%

Section: Results Of Management Optionsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Management of duplex system ureteroceles in neonates and infants

Castagnetti

El-Ghoneimi

2009

Nat Rev Urol

View full text Add to dashboard Cite

show abstract

“…In a series of 165 patients, Husman and al show that in ectopic ureteroceles, reoperation rate for treating postoperative reflux in a group of patients with no preoperative reflux, was 15% after nephrectomy and upper pole, against 64% after endoscopic incision. In a second group of patients with preoperative reflux, the rate of reoperation in the bladder level is 84% after pole nephrectomy or after endoscopic incision [12].…”

Section: Discussionmentioning

confidence: 98%

Report of a clinic case of a double system ectopic ureterocele in an African infant

Fall

Sagna

et al. 2014

Journal of Pediatric Surgery Case Reports

View full text Add to dashboard Cite

a b s t r a c tWe report on the observation of a 30-month-old female newborn that was treated for a urinary infection. The medical imaging revealed the existence of a right double system ureterocele with vesicorenal reflux on the ureter of the upper pyelon and a bifid left ureter. The treatment consisted in an ureterocelectomy, a reimplantation of the two right ureters and a repair of the vesical floor. The external drainage of the upper pyelon allowed us to make sure of its functionality that was about 15% of the full renal function. The post-op follow-ups have been simple and thirteen months later, the newborn is doing well and does not present any sign of urinary infection.

show abstract

The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles

Bolduc¹,

Upadhyay²,

Restrepo

et al. 2003

BJU International

View full text Add to dashboard Cite

review by a pathologist, describing five histological categories, i.e. chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Histological lesions were categorized as severe (> 25%) or minimal ( £ 25%). Radiological features and the histology of UPN were then analysed, and correlated using Fisher's exact test and multivariate analysis. RESULTSSevere histological lesions were reported in 38 specimens (69%) and minimal lesions in 17 UPN specimens (31%). Severe parenchymal thinning was associated with a severe pathological lesion ( P < 0.02). There was no correlation with the echogenicity or degree of hydronephrosis. Dysplasia, found in 64% of specimens, did not correlate with increased echogenicity. Minimally functioning upper poles on nuclear renal scan ( £ 4% overall function) were significantly associated with severe histological lesions ( P = 0.01). There was no correlation between diagnostic imaging features and the mode of presentation or type of ureterocele. CONCLUSIONSMultivariate analysis, severe parenchymal thinning on renal US and minimal function on nuclear renal scan can be used to predict the severity of histological lesions of the upper pole. These results may be helpful in the making therapeutic decisions for patients with ureteroceles in duplex systems. KEYWORDS ureteroceles, duplex kidney, upper pole nephrectomy, histology and diagnostic imaging OBJECTIVETo compare the diagnostic imaging findings with the histological lesions in upper pole nephrectomy (UPN) specimens of duplex system ureteroceles, using renal ultrasonography (US) and nuclear renal scintigraphy. PATIENTS AND METHODSBetween 1992 and 2000, 86 patients with a ureterocele in a duplex system underwent surgery. The results from US were reviewed in 84 patients by a radiologist, for echogenicity, parenchymal thinning and hydronephrosis; 77 nuclear renal scans describing the differential function of the upper poles were also reviewed. Fifty-five patients underwent UPN (25 antenatal, 30 postnatal; 18 intravesical, 37 extravesical) and the specimens were available for independent

show abstract

Management of Ectopic Ureterocele Associated With Renal Duplication: A Comparison of Partial Nephrectomy and Endoscopic Decompression

Cited by 8 publications

References 14 publications

Management of duplex system ureteroceles in neonates and infants

Management of duplex system ureteroceles in neonates and infants

Report of a clinic case of a double system ectopic ureterocele in an African infant

The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles

Contact Info

Product

Resources

About