Clinical Manifestations and Indications for Management of Ureteroceles in Adults / 대한비뇨기과학회지

ABSTRACT

PURPOSE: To review the clinical manifestations, indications and the management outcomes of adult patients with ureteroceles. MATERIALS AND METHODS: Between 1995 and 2006, 20 adult patients (9 females, 3 males) with ureteroceles were investigated for their clinical symptoms, type of ureterocele and renal function. The outcomes of surgical or conservative management, according to the patients' symptoms were also individually analyzed. The median follow-up was 38 months (12-50 months). RESULTS: The ages at diagnosis of the ureteroceles ranged from 19 to 70 years (mean 37.9 years). The ureterocele-related symptoms were flank pain (3), hematuria (1) and lower urinary tract symptoms (4). Two cases were incidentally detected with ultrasound (1) or computed tomography (1), and another 2 patients presented with non-specific flank pain or a hematuria. Eight patients exhibited an intravesical single system and 4 were associated with upper pole of a duplex system. Only one patient had an ectopic ureterocele, in which the orifice was located in the mid-urethra. The ureterocele-related symptoms were managed using a transurethral incision (5) or resection (1) of the ureterocele, with ureteroscopic stone retrieval (2). The symptoms were resolved after surgery, and there were no recurrence of symptoms or any deterioration of the renal function during follow-up. CONCLUSIONS: To diagnose an ureterocele in adult patients requires a high index of suspicion, as not all patients present with the typical clinical manifestations associated in children. Our results suggested that ureterocele-related symptoms are the main indication for surgery in adult patients. While methods with lower morbidity may be a useful, expectant treatment, they may also be an appropriate option for the management of incidentally detected ureteroceles.