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

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Urology and Urological Science Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Jee Soo Park, Yong Seung Lee, Sang Woon Kim & Sang Won Han

  2. Department of Pediatric Urology, Severance Children’s Hospital, Seoul, Republic of Korea

    Cho Nyeong Lee & Sung Hoon Kim

  3. Department of Urology, Good Moonhwa Hospital, Busan, Republic of Korea

    Hyeyoung Lee

Authors
  1. Jee Soo Park
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  2. Yong Seung Lee
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  3. Cho Nyeong Lee
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  4. Sung Hoon Kim
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  5. Sang Woon Kim
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  6. Hyeyoung Lee
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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.

Corresponding authors

Correspondence to Yong Seung Lee or Sang Won Han.

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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.

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Park, J.S., Lee, Y.S., Lee, C.N. et al. Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems. World J Urol 37, 2237–2244 (2019). https://doi.org/10.1007/s00345-018-2607-x

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  • DOI: https://doi.org/10.1007/s00345-018-2607-x

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