Ureterocele Associated with Ureteral Duplication and a Nonfunctioning Upper Pole Segment

Abstract

We reviewed the records of 87 patients with a ureterocele associated with duplication and a nonfunctioning upper pole segment. All patients involved in this study were treated by partial nephroureterectomy and observation. Additional surgery to correct vesicoureteral reflux became necessary in 54 cases (62%). A careful retrospective chart and radiographic review identified that the need for additional surgery was directly related to the number of renal moieties that had a ureterocele or vesicoureteral reflux present. In particular, when a ureterocele alone was present 21 of 21 patients (100%) did not require additional surgery. When low grade (less than 3/5) reflux was present into 1 ureter 8 of 15 patients (60%) did not require surgery. The presence of high grade reflux into 1 moiety or vesicoureteral reflux into more than 1 moiety, regardless of the grade of reflux, almost inevitably resulted in the need for further surgery with only 2 of 50 patients (4%) with these abnormalities cured by partial nephroureterectomy alone. Our data suggest that this latter group of patients may be treated more efficaciously by complete genitourinary reconstruction rather than partial nephroureterectomy alone.

Endoscopic Puncture of Ureterocele as a Minimally Invasive and Effective Long–Term Procedure in Children

“…However, there are some authors who recommend preservation even these small portions of functioning parenchyma and avoiding partial nephrectomy [7], but others advocate a more extensive reconstruction consisting of partial nephroureterectomy with ureter reimplantation in those patients with ectopic ureterocele with a nonfunctioning pole and coexisting reflux [1, 3, 4]. In our series, the majority of patients had a poorly functioning ureterocele moiety – <20% – which was determined by either DMSA or DTPA renal scan.…”

“…The traditonal treatment of ureterocele associated with duplication includes upper pole partial nephrectomy with or without ureterocele incision and, if needed, ureteric reimplantation through a separate surgical approach [1, 4]. …”

“…Extravesical–retroperitoneal approach, open marsupialization of the ureterocele with ipsilateral reimplantation and upper pole heminephrectomy alone were proposed as simplified approaches for those patients [1, 2, 3, 4, 5, 6, 7, 8]. Unroofing of the ureterocele or endoscopic puncture are not the preferred treatment, but advocated frequently as a drainage procedure for an infected system before definitive surgery [1, 5, 8].…”

“…Once the diagnosis of ureterocele has been made, all efforts should be taken to prevent UTI, preserving renal function, enhancing subsequent reconstructive surgery and maintaining continence. The treatment options vary from complicated complete reconstruction or resection to a simplified approach of endoscopic drainage of the obstructed renal unit with function preservation of the attached moiety [1, 2, 3, 4, 5, 6, 7, 8]. We have retrospectively evaluated our long–term results in children in whom primary endoscopic decompression of a ureterocele was performed focusing on the secondary operation rate, preservation of renal function and complication rate such as vesicoureteral reflux (VUR) following puncture, recurrent UTIs and incontinence.…”

Heminephrectomy in Adults: A Systematic Review with Cumulative Analysis

“…Further 5 studies were excluded as they were duplicate publications. Ten further studies were excluded for the following reasons: 8 studies included paediatric patients as well as adults, with no differentiation of results and outcomes [15-22]; one study was excluded as it was a clinical review of the topic with no data presented [23]; and lastly, one publication was excluded as it investigated the utility of heminephrectomy for horseshoe kidney rather than duplex kidney [24]. One study was found through the searching of reference lists of included articles.…”