Endoscopic treatment of ureterocele in children: Results of a single referral tertiary center over a 10 year-period

  • Author Footnotes
    1 ‘Present Address’: Pediatric Surgery Department, Presidio Ospedaliero Santa Chiara, Largo Medaglie d’Oro 9, 38122 Trento (TN), Italy.
    Elisa Pani
    Correspondence
    Correspondence to: Elisa Pani, Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
    Footnotes
    1 ‘Present Address’: Pediatric Surgery Department, Presidio Ospedaliero Santa Chiara, Largo Medaglie d’Oro 9, 38122 Trento (TN), Italy.
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
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  • Elisa Negri
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
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  • Chiara Cini
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
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  • Luca Landi
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
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  • Alberto Mantovani
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
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  • Giulia Bortot
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
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  • Lorenzo Masieri
    Affiliations
    Pediatric Urology Department, Azienda Ospedaliero-Universitaria Meyer, Viale G. Pieraccini 24, Firenze, 50139, FI, Italy
    Search for articles by this author
  • Author Footnotes
    1 ‘Present Address’: Pediatric Surgery Department, Presidio Ospedaliero Santa Chiara, Largo Medaglie d’Oro 9, 38122 Trento (TN), Italy.
Published:December 23, 2021DOI:https://doi.org/10.1016/j.jpurol.2021.12.008

      Summary

      Introduction

      The management of UCs remain controversial, especially for UCs with duplex collecting systems that still represent a great challenge in paediatric urology. Several approaches have been used and a shared management is not yet validated.

      Study aim

      Aim of our study is to evaluate the results of the endoscopic treatment of UC comparing ortothopic single-system UC and ectopic duplex-system UC over a 10-year period in a single referral tertiary center. Success was defined as resolution of dilation, lack of urinary infections and preservation of renal function.

      Study design

      We retrospectively reviewed medical records of children with a diagnosis of UC who underwent endoscopic puncture at our division from January 2009 to January 2019. Patients were divided in two groups: Group A composed of patients with ectopic UC associated with renal duplex system and Group B with orthotopic UC in single collecting system.

      Results

      We identified 48 paediatric patients treated with transurethral primary endoscopic incision. Groups result homogeneous for clinical and pathological characteristics. The only statistical significative difference between the two samples was the age at diagnosis (p value with Yates correction = 0.01).

      Discussion

      We considered as a therapeutic success infections control and the elimination of obstruction with preservation of global kidney function. Based on that, our success rate after single (77%) or double (92%) endoscopic treatment is higher than data reported in literature. Differently from previous studies, vescico-ureteral reflux without UTIs was not considered as a failure of the procedure. The present study has some limitations: it is a retrospective and monocentric serie and it lacked a longer follow-up; on the other hand, it has been conducted on a quite large sample size and it is one of the few studies that compares the endoscopic treatment between orthotopic and ectopic UC.

      Conclusion

      Summary TablePost treatment data were summarized in Table 3.
      Persistent UTIs Persistent VUR “De Novo” VUR UC sac bulging requiring second look
      Group A 11 (42.3%) 1 (3.8%) 5 (19.2%) 6∗ (23.1%)
      Group B 4 (18.2%) 1 (4.5%) 0 (0%) 2 (9.1%)
      P Value (Yates correction) 0.14 0.54 0.09 0.36

      Abbreviations:

      UC (Ureteocele), Ectopic UC (Ectopic Ureterocele)

      Keywords

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