Ectopic ureterocele management in children remains a controversial subject without a clear consensus. The purpose of this study was to explore the risk factors for adverse outcomes and secondary surgery in pediatric patients with unilateral ectopic duplex system ureterocele, a complex urinary system deformity with controversial treatment.
Materials and methods
We retrospectively reviewed 75 patients with unilateral ectopic duplex system ureterocele who underwent surgery at the Shengjing Hospital of China Medical University between January 1, 2008, and September 31, 2020. Demographic characteristics, preoperative data, surgical procedures, postoperative adverse outcomes, and secondary surgery were recorded. Adverse outcomes were defined as new-onset VUR and BOO after surgery. The risks of adverse outcomes and secondary surgery were evaluated using multivariate binary logistic regression and expressed as adjusted odds ratios with 95% confidence intervals.
Adverse outcomes occurred in 25 (33.3%) patients, including 24 (32.0%) with new-onset vesicoureteral reflux and 1 (1.3%) with bladder outlet obstruction. Seven (9.3%) patients required secondary surgery. The independent risk factors for adverse outcomes were transurethral endoscopic incision and transurethral endoscopic puncture (transurethral endoscopic incision vs. upper pole partial nephrectomy: OR = 11.049, P = 0.004; transurethral endoscopic puncture vs. upper pole partial nephrectomy: OR = 33.222, P = 0.002).
The definitive treatment for duplex system ureterocele remains controversial. We found that transurethral endoscopic incision or puncture was an independent risk factor for adverse outcomes. The main limitation of this study would be its retrospective nature and relatively short follow-up period. Furthermore, 30 children were younger than 5 years at last follow up, and thus, we could not efficiently evaluate their voiding function.
Summary TableMultivariate binary logistic regression analysis of the risk factors for adverse outcomes and secondary surgery.
|Variables||Multivariate binary logistic regression of adverse outcomes||Multivariate binary logistic regression of secondary surgery|
|Age at operation (<6 months vs. ≥6 months)||0.720||0.144–3.606||0.689||4.646||0.537–40.165||0.163|
|Preoperative SRF of upper moiety||0.969||0.889–1.057||0.483||1.013||0.899–1.142||0.832|
|Maximum diameter of ureterocele||0.966||0.899–1.038||0.350||0.945||0.851–1.051||0.297|
|Preoperative fUTI (yes vs. no)||0.545||0.151–1.964||0.353||0.953||0.137–6.606||0.961|
|Time of diagnosis (antenatal vs. postnatal)||1.679||0.303–9.303||0.553||-||-||0.998|
|Procedures UPPN (Reference)|
OR, odds ratio; CI, confidence interval; SRF, split renal function; fUTI, febrile urinary tract infection; TUI, transurethral endoscopic incision; TUP, transurethral endoscopic puncture; CSR, common sheath reimplantation; UPPN, upper pole partial nephrectomy.
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Published online: October 18, 2022
Accepted: October 14, 2022
Received in revised form: September 27, 2022
Received: April 26, 2022
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