Effectiveness of endoscopic treatment of duplex system ureteroceles in children

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Abstract

Objective. The aim of this study is to evaluate the efficiency of transurethral incision of ureteroceles and incidence of vesicoureteral reflux in pediatric patients with duplex system ureterocele.

Materials and methods. This is a retrospective study of 155 pediatric patients with duplex system ureterocele. The age of patients at the time of surgery ranged from 5 days to 17 years (median — 8.0 months). Intravesical ureterocele had 108 patients (69.8%), extravesical — 47 (30.2%).

Results. Complications occurred in 2 patients (1.3%), recurrence obstruction was in 1 case (0.6%). Ipsilateral vesicoureteral reflux after surgery had 112 patients (72.3%): in the upper pole — 51 cases (32.9%), in the lower pole — 32 (20.6%), in both ureters — 29 (18.7%). In the long-term period after transurethral incision of ureteroceles 97 patients (62.5%) needed reoperation due to infection and voiding dysfunction. Statistically significant risk factors associated with the need for reoperation were the presence of vesicoureteral reflux on the ureteroceles side and non-functioning upper pole of the kidney.

Conclusion. Transurethral incision of ureteroceles for duplex system ureterocele is a safe and effective minimally invasive method of primary resolving of the obstruction. Vesicoureteral reflux on the ureterocele side after surgery had 72.3% of patients; reoperation in the long term was necessary in 62.5% cases. The main risk factor reoperation is vesicoureteral reflux on the ureterocele side.

About the authors

Vitaly I. Dubrov

2nd Сity Children’s Clinical Hospital

Author for correspondence.
Email: dubroff2000@mail.ru

Cand. Sci. (Med.), Head of the Department of Urology

Belarus, Minsk

Alexandr V. Strotsky

Belarusian State Medical University

Email: astrotsky@mail.ru

Dr. Sci. (Med.), Professor, Head of the Department of Urology

Belarus, Minsk

Aleksey O. Shkutov

2nd Сity Children’s Clinical Hospital

Email: shkutov@yandex.ru

Urologist, Department of Urology

Russian Federation, Minsk

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Supplementary files

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2. Fig. 1. Age groups of patients

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3. Fig. 2. Function of the upper pole of the kidney on static nephroscintigraphy: a — non-functioning, b — poorly functioning, c — normally functioning

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4. Fig. 3. Voiding cystourethrogram in a female with uncut urethral part of the ureterocele shows infravesical obstruction, grade III VUR in the lower pole of the left kidney, wide extravesical part of the ureterocele blocking the urethra

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