ABSTRACT
PURPOSE: Endoscopic incision was performed as the initial therapy for ureteroceles in children presenting to our institutions between 1985 and 1990. To assess the long-term efficacy of this treatment modality we reevaluated the outcome of these patients. MATERIALS AND METHODS: Parameters reviewed included patient age at surgery, position of the ureterocele, a duplex system, preoperative and postoperative reflux, and the need for additional operations. Statistical analysis consisted of chi-square and Wilcoxon's rank sum tests. RESULTS: Of the patients 22 had intravesical and 22 had extravesical ureteroceles. Average age at initial surgery was 1.9 +/- 3.7 years with average followup of 7.2 +/- 3.1 years. A second operation was required in 18 cases (41%), which was significantly more likely for an extravesical ureterocele (18% versus 64%, p = 0. 002), a duplex system (p = 0.026) or preoperative reflux (p = 0.02). Second operations included reimplantation in 13 cases, upper pole partial nephrectomy in 7, total nephroureterectomy in 3, bladder neck reconstruction in 3 and lower pole pyeloplasty in 3. The only secondary operations performed for intravesical ureteroceles were reimplantation in 3 cases and upper pole nephrectomy in 1. New onset reflux developed in 14 of 27 patients (52%) postoperatively, including 7 with intravesical and 7 with extravesical ureteroceles. None required a second open operation. CONCLUSIONS: With extended followup the percentage of patients requiring open surgery after endoscopic incision of ureteroceles increased from our original report of 27% to 41% (p = 0.166). Only 18% of cases with an intravesical ureterocele required a subsequent operation compared to 64% with an extravesical ureterocele (p = 0.002). The reduction in size of the obstructed ureter following endoscopic decompression facilitated successful reimplantation. Endoscopic puncture permits definitive treatment in the majority of children by at most a single incision, open operation at the bladder level.
Subject(s)
Ureterocele/surgery , Ureteroscopy , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Reoperation , Replantation , Treatment Outcome , Ureter/surgery , Vesico-Ureteral Reflux/etiologyABSTRACT
A total of 51 children, mostly less than 2 years old, underwent endoscopic incision of ureteroceles as a primary form of treatment. In 73% no further surgery was required. Of the patients 19 were diagnosed by prenatal ultrasound, with a urinary tract infection the usual presenting symptom in the remainder. Of 27 intravesical cases endoscopic incision resulted in decompression of the ureterocele in 93%, with preservation of upper pole function in 96%, and secondary surgical procedures were required in 7%. Reflux was created in 18% and it persisted in 2 of 4 patients. Of 24 cases of ectopic (extravesical) ureteroceles incision resulted in decompression in 75%, with upper pole function preserved in 50%. Reflux was created in 47% and a secondary surgical procedure was performed in 50%. Preservation of upper pole function was significantly better for intravesical versus ectopic ureteroceles (p < 0.01), and the requirement for secondary surgical procedure was greater with ectopic ureteroceles (p < 0.01). Three patients had intermittent bladder outlet obstruction following the incision and required further surgery. The 2 different techniques for incision of intravesical and ectopic ureteroceles are described. The role of endoscopic incision in the overall management of ureteroceles is confirmed by this review, and the need for partial nephroureterectomy may diminish.
Subject(s)
Ureterocele/surgery , Adolescent , Child , Child, Preschool , Endoscopy/methods , Follow-Up Studies , Humans , Infant , Reoperation , Treatment Outcome , Ureterocele/pathology , Urinary BladderABSTRACT
Herein we describe a modification of the Beck-von Hacker procedure which we utilize in the treatment of hypospadias and distal urethrocutaneous fistulas. The indications and the results achieved with this technique are presented.
Subject(s)
Hypospadias/surgery , Urethra/surgery , Child , Child, Preschool , Humans , Infant , Surgical Procedures, Operative/methodsABSTRACT
A case of ureteropelvic junction obstruction in a girl with previously normal pyelogram is presented. The aetiology of this development is unclear but this report emphasizes the need for a close follow-up of patients with persistent flank pain even if the initial pyelograms are normal.
Subject(s)
Ureteral Obstruction/diagnostic imaging , Child , Female , Follow-Up Studies , Humans , Kidney Pelvis/diagnostic imaging , Time Factors , Ureteral Obstruction/congenital , Ureteral Obstruction/epidemiology , UrographyABSTRACT
The authors reviewed the records of 160 patients with neurogenic bladder secondary to myelomeningocele (MMC) treated at the Urology Department of the University of Padua during 1977-1988. All patients had been evaluated by excretory urography, urethrocystography and videocystomannometry (VCM). Urodynamic studies are fundamental in determining vesicosphincteric dysfunction and patients who are at high risk for early renal lesions. For this reason, the authors recommend urodynamic evaluation from the first year of the infant's life in order to institute treatment early. The therapeutic approach should aim at a) preserving renal function, b) achieving a socially acceptable degree of urinary continence, and c) protecting sexual function.
