Radiological Findings after Endoscopic Incision of Ureterocele

PURPOSE: Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. MATERIALS AND METHODS: We retrospectively reviewed the radiological findings ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)] in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M: F=3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when urinary tract obstruction improved without additional treatment, partially successful when medical treatment was still required, and second operation when additional surgical treatment was required. RESULTS: Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchyma was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grade 3 during the follow-up period was required by nine (56%). CONCLUSION: Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of urinary tract obstruction, while to assess the extent of VUR during the follow-up period, postoperative VCU is required.

The Significance of Beaking Sign on Cystography in Stress Urinary Incontinence

PURPOSE: To evaluate the clinical and urodynamic significance of the beaking sign at cystography in patients with stress urinary incontinence (SUI). MATERIALS AND METHODS: We retrospectively reviewed the cystograms of 253 patients with SUI, defining the beaking sign as the triangular contrast collection below the bladder base in the resting state without overt leakage. Various clinical parameters including patient age, symptom duration, parity, the one-hour pad test, and urodynamic study data including Valsalva leak point pressure (VLPP) and maximal urethral closing pressure (MUCP) were compared between the beaking-positive and the beaking-negative group. The distribution of Blaivas type in SUI between these two groups was also analysed. RESULTS: The beaking sign was observed in 153 patients (60%). Those who were older and showed greater parity more often belonged to the beaking-positive group than the beaking-negative (p<0.05). Both VLPP and MUCP were significantly lower in the beaking-positive group than in beaking-negative group (p=0.03; p=0.01, respectively). Type-0 or -I SUI was more common in the beaking-negative group, while the frequency of other types was similar between the two groups. CONCLUSION: The beaking sign has clinical and urodynamic significance, reflecting functional deficiencies of the intrinsic sphincter, and may possibly be regarded as an additional parameter in the planning of treatment.