Summary
Introduction
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.
Results
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).
Discussion
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.
Conclusions
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 | ||||
|---|---|---|---|---|---|---|
| OR | 95%CI | P-value | OR | 95%CI | P-value | |
| 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) | ||||||
| TUI | 11.049 | 2.148–56.822 | 0.004 | 2.087 | 0.158–27.554 | 0.576 |
| TUP | 33.222 | 3.654–302.062 | 0.002 | 2.275 | 0.095–54.266 | 0.612 |
| CSR | - | - | 0.999 | - | - | 0.999 |
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.
Keywords
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Article info
Publication history
Published online: October 18, 2022
Accepted:
October 14,
2022
Received in revised form:
September 27,
2022
Received:
April 26,
2022
Identification
Copyright
© 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
