Clinical Outcome of Various Surgical Methods for the Ureteroceles in Children / 대한비뇨기과학회지

ABSTRACT

Purpose: We reviewed our experience in the management of ureteroceles in children as we selected the surgical method according to the patients' age and the differential function of the affected renal unit. Materials and Methods: Thirty-six children (10 boys, 26 girls) with ureteroceles who received surgical management between 1991 and 2003 and were followed up for at least 12 months postoperatively were the subjects of this study. Age at operation ranged from 1 month to 10 years (median 6.5 months) and patients were followed up for an average of 43 months postoperatively (12-103 months). Results: Twenty patients had functioning renal units, 16 including 4 infants, of which received transurethral incision (TUI), 3 ureteroureterostomy and 1 ureteroneocystostomy after ureterocelectomy. Eight of the 16 patients (50%) who received TUI developed de novo vesicoureteral reflux (VUR), 5 of whom requiring secondary open procedure. Of the 16 patients with nonfunctioning renal units who received either heminephrectomy or nephrectomy, 6 required secondary open procedures for persistent ureteral obstruction or bladder outlet obstruction. On follow-up, of the 20 patients with initially functioning renal units, 19 maintained preoperative level of renal function and all remained free of urinary tract infection (UTI). Conclusions: In surgical approach to the ureteroceles, individualization with respect to the function of the affected unit and the age of the patient appears to be effective in controlling UTI and preserving the renal function. TUI, despite the high rate of de novo VUR, may be a useful option in immediate decompression of the obstructed urinary tract in the face of acute UTI especially in younger children.