Advertisement

Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems

  • Jee Soo Park
  • Yong Seung LeeEmail author
  • Cho Nyeong Lee
  • Sung Hoon Kim
  • Sang Woon Kim
  • Hyeyoung Lee
  • Sang Won HanEmail author
Original Article

Abstract

Purpose

Treatment strategies for children with ectopic ureteroceles (EUs) and duplex collecting systems or vesicoureteral reflux are controversial. Transurethral incision (TUI) of EUs associated with duplex systems has been considered only as a temporizing technique. This study aimed to evaluate whether primary TUIs could be considered as an initial treatment option in EUs with duplex systems.

Materials and methods

Forty-seven children with EUs associated with duplex systems underwent primary TUIs at our institution between November 2007 and October 2017. We retrospectively analyzed patient characteristics such as age, sex, upper tract status, ureterocele location, differential renal function, and preoperative vesicoureteral reflux with regard to postoperative complications requiring additional surgery, postoperative incontinence, and renal function.

Results

The mean age at operation was 4.8 ± 4.7 months. Of the 47 patients, 26 (55.3%) underwent primary TUIs only, 3 (6.4%) underwent secondary TUIs, and 18 (38.3%) underwent other secondary procedures such as common-sheath reimplantation (CSR) and ureterocelectomy. Secondary surgeries in 21/47 (44.7%) patients occurred during a mean follow-up of 47.7 ± 23.3 months, and the most common type of secondary surgery was CSR. The most common reason for secondary surgery was febrile urinary tract infection (14/21 patients [66.7%]). There were three cases (3/26 [11.5%]) of voiding problems after primary TUI and two cases (2/15 [13.4%]) after secondary CSR.

Conclusions

Primary TUIs should be considered as initial treatment options for EUs in duplex systems and not just a temporizing technique.

Keywords

Ectopic ureterocele Transurethral incision Duplex system 

Notes

Acknowledgements

The authors would like to thank Dong-Su Jang, MFA, (Medical Illustrator) for his help with the illustrations.

Author contributions

JSP: project development, data analysis, and manuscript writing/editing. YSL: project development, data analysis, and manuscript editing. CNL: data collection. SHK: data collection. SWK: project development and data analysis. HL: data collection. SWH: project development, data analysis, and manuscript editing.

Compliance with ethical standards

Conflict of interest

All of the authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was not required for the purposes of this study, as it was based upon retrospective anonymous patient data and did not involve patient intervention or the use of human tissue samples.

References

  1. 1.
    Decter RM, Sprunger JK, Holland RJ (2001) Can a single individualized procedure predictably resolve all the problematic aspects of the pediatric ureterocele? J Urol 165:2308–2310CrossRefGoogle Scholar
  2. 2.
    Lee YS, Im YJ, Shin SH (2015) Complications after common sheath reimplantation in pediatric patients with complicated duplex system. Urology 85:457–462CrossRefGoogle Scholar
  3. 3.
    Adorisio O, Elia A, Landi L (2011) Effectiveness of primary endoscopic incision in treatment of ectopic ureterocele associated with duplex system. Urology 77:191–194CrossRefGoogle Scholar
  4. 4.
    Petite T, Ravasse P, Delmasse P (1999) Does the endoscopic incision of ureterocele reduce the indication for partial nephrectomy? BJU Int 83:675–678CrossRefGoogle Scholar
  5. 5.
    Gearhart JP, Rink RC, Mouriquand PD (2010) Pediatric urology, 2nd edn. Elsevier, PhiladelphiaGoogle Scholar
  6. 6.
    Plaire JC, Pope JC, Kropp BP et al (1997) Management of ectopic ureters: experience with the upper tract approach. J Urol 158:1245–1247CrossRefGoogle Scholar
  7. 7.
    Coplen DE, Barthold JS (2000) Controversies in the management of ectopic ureteroceles. Urology 56:665–668CrossRefGoogle Scholar
  8. 8.
    Shokeir AA, Nijman RJ (2002) Ureterocele: an ongoing challenge in infancy and childhood. BJU Int 90:777–783CrossRefGoogle Scholar
  9. 9.
    Byun E, Merguerian PA (2006) A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. J Urol 176:1871–1877CrossRefGoogle Scholar
  10. 10.
    Khoury AE, Bägli DJ (2016) Vesicoureteral reflux. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (eds) Campbell-Walsh urology, 11th edn. Saunders, Philadelphia, pp 3138–3139Google Scholar
  11. 11.
    Neveus T, von Gontard A, Hoebeke P et al (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 176:314–324CrossRefGoogle Scholar
  12. 12.
    Beganovic A, Klijn AJ, Dik P et al (2007) Ectopic ureterocele: long-term results of open surgical therapy in 54 patients. J Urol 178:251–254CrossRefGoogle Scholar
  13. 13.
    Wang MH, Greenfield SP, Williot P et al (2008) Ectopic ureteroceles in duplex systems: long-term follow up and treatment-free status. J Pediatr Urol 4:183–187CrossRefGoogle Scholar
  14. 14.
    Han MY, Gibbons MD, Belman AB et al (2005) Indications for nonoperative management of ureteroceles. J Urol 174:1652–1656CrossRefGoogle Scholar
  15. 15.
    Shankar KR, Vishwanath N, Rickwood AMK (2000) Outcome of patients with prenatally detected duplex system ureterocele: natural history of those managed expectantly. J Urol 165:1226–1228CrossRefGoogle Scholar
  16. 16.
    Jayanthi VR, Koff SA (1999) Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems. J Urol 162:1077–1080CrossRefGoogle Scholar
  17. 17.
    Jelloul L, Berger D, Frey P (1997) Endoscopic management of ureteroceles in children. Eur Urol 32:321–326PubMedGoogle Scholar
  18. 18.
    Marr L, Skoog SJ (2002) Laser incision of ureterocele in the pediatric patient. J Urol 167:280–282CrossRefGoogle Scholar
  19. 19.
    Jankowski JT, Palmer JS (2006) Holmium: yttrium–aluminum–garnet laser puncture of ureteroceles in neonatal period. Urology 68:179–181CrossRefGoogle Scholar
  20. 20.
    Lee YS, Hah YS, Kim MJ et al (2012) Factors associated with complications of the ureteral stump after proximal ureteroureterostomy. J Urol 188:1890–1894CrossRefGoogle Scholar
  21. 21.
    Abrahamsson K, Hansson E, Sillen U et al (1998) Bladder dysfunction: an integral part of the ectopic ureterocele complex. J Urol 160:1468–1470CrossRefGoogle Scholar
  22. 22.
    Vereecken RL, Proesmans W (2000) Extensive surgery on the trigone for complete ureteral duplication does not cause incontinence or voiding problems. Urology 55:267–270 (discussion: 270-261) CrossRefGoogle Scholar
  23. 23.
    Coplen DE, Duckett JW (1995) The modern approach to ureteroceles. J Urol 153:166–171CrossRefGoogle Scholar
  24. 24.
    Ziylan O, Oktar T, Korgali E et al (2005) Lower urinary tract reconstruction in ectopic ureteroceles. Urol Int 74:123–126CrossRefGoogle Scholar
  25. 25.
    Blyth B, Passerini-Glazel G, Camuffo C et al (1993) Endoscopic incision of ureteroceles: intravesical versus ectopic. J Urol 149:556–560CrossRefGoogle Scholar
  26. 26.
    Monfort G, Guys JM, Coquet M et al (1992) Surgical management of duplex ureteroceles. J Pediatr Surg 27:634–638CrossRefGoogle Scholar
  27. 27.
    Rich MA, Keating MA, Snyder HM III et al (1990) Low transurethral incision of single system intravesical ureteroceles in children. J Urol 144:121–122CrossRefGoogle Scholar
  28. 28.
    Smith G, Gosalbez R, Parrott TS et al (1994) Transurethral puncture of ectopic ureteroceles in neonates and infants. J Urol 152:2110–2112CrossRefGoogle Scholar
  29. 29.
    Hagg MJ, Mourachov PV, Snyder HM et al (2000) The modern endoscopic approach to ureterocele. J Urol 163:940–943CrossRefGoogle Scholar
  30. 30.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  31. 31.
    Castagnetti M, Vidal E, Burei M et al (2013) Duplex system ureterocele in infants: should we reconsider the indications for secondary surgery after endoscopic puncture or partial nephrectomy? J Pediatr Urol 9:11–16CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jee Soo Park
    • 1
  • Yong Seung Lee
    • 1
    Email author
  • Cho Nyeong Lee
    • 2
  • Sung Hoon Kim
    • 2
  • Sang Woon Kim
    • 1
  • Hyeyoung Lee
    • 3
  • Sang Won Han
    • 1
    Email author
  1. 1.Department of Urology and Urological Science InstituteYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Pediatric UrologySeverance Children’s HospitalSeoulRepublic of Korea
  3. 3.Department of UrologyGood Moonhwa HospitalBusanRepublic of Korea

Personalised recommendations