Summary
Introduction
The best surgical approach to ectopic ureters and ureteroceles is yet to be determined.
The objective of this study is to provide an alternative lower tract surgical approach
to ectopic ureters and duplex system ureteroceles that can be safely performed in
young children.
Methods
The “in-and-out” bladder approach was performed via an open intravesical incision.
The upper and lower pole ureters were mobilized and brought into the bladder. The
dilated ureter/ureterocele was cut open, and the distal part was deuroepithelialized.
Subsequently, common sheath reimplantation was performed. The ureterocele wall was
not involved during the whole procedure. We retrospectively reviewed all patients
who underwent surgery for ureteroceles and ectopic ureters between January 1, 2004,
and December 31, 2019. Patients with intravesical ureteroceles were excluded. Outcome
parameters included the presence of hydronephrosis or reflux, split renal function
on DMSA scan, incidence of urinary tract infection, and urinary incontinence.
Results
A total of 32 patients with ectopic duplex system ureterocele who underwent the “in-and-out”
bladder approach between 2004 and 2019 were included in the retrospective study. The
median age at operation was 7.8 months (range: 1.5 months–3.0 years). The median length
of follow-up was 6.1 years (range: 1.0 years–14.3 years). Sixteen patients (55%) had
ipsilateral vesicoureteral reflux. Five patients postoperatively developed a urinary
tract infection within 1–3 years. No patients required further endoscopic treatment
or surgeries. During long-term follow-up, two patients (6.3%) had intermittent day
wetting at the ages of 4 and 5 years and were managed conservatively. The symptoms
of intermittent day wetting subsided during follow-up.
Conclusions
Graphical AbstractProcedure of the “in-and-out bladder” approach to surgically treating ectopic ureterocele.
(a) A mucosal incision was made along the lower edge of the orifice of the lower pole
ureter. (b) A 7-0 polydioxanone stay suture was performed on the orifice of the ipsilateral
lower pole ureter to facilitate the dissection. The lower pole ureter was then dissected
out and cut open. (c) The mucosal layer of the distal stump/ureterocele was detached
as distally as possible and ligated intramurally. (d) Common sheath reimplantation
was performed through a submucosal tunnel.
Keywords
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Article info
Publication history
Published online: October 11, 2022
Accepted:
October 6,
2022
Received in revised form:
September 9,
2022
Received:
February 15,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
