Summary
Background
As a congenital anomaly, ureteroceles occur in 1 in 4000 children, and are usually
diagnosed prenatally. However, there remains a lack of definite consensus on the optimal
management of congenital ureteroceles.
Objective
We evaluated factors associated with success of primary transurethral incision (TUI)
in ureterocele pediatric patients.
Methods
Demographic and clinical information for 120 pediatric patients who were diagnosed
with congenital ureterocele between 1993-2021 at our institution were obtained through
retrospective chart review. Data were analyzed using Fisher’s exact tests, t-tests,
and logistic regression with a significance threshold of p<0.05. The primary outcome
of ureterocele management was TUI effectiveness, defined by no need for further surgical
intervention.
Results
Of the 120 patients (39 boys, 81 girls) with ureteroceles, 75 patients (22 boys, 53
girls) met our inclusion criteria of undergoing initial TUI ureterocele. Initial TUI
was effective in 51/75 patients (68.0%). We analyzed possible correlative factors
for TUI efficacy, which are summarized in . Simplex system was a significant predictor
of primary TUI efficacy (85% effective in simplex systems, 62% in duplex systems).
Prior urinary tract infection, prenatal diagnosis, and electrocautery technique were
all associated with an increased risk of needing additional surgeries after primary
TUI.
Discussion
Simplex system was the most significant predictor of effective primary TUI, and the
absence of preoperative vesicoureteral reflux was also significant. Prenatal diagnosis,
preoperative febrile urinary tract infection, higher preoperative hydronephrosis grade,
and the use of electrocautery were all associated with decreased primary TUI efficacy.
Study limitations include that it was a retrospective chart review, and cohort size
was limited by incomplete urology follow-up and operative records.
Conclusions
Initial TUI was an effective procedure for the majority of our pediatric ureterocele
patients, a higher success rate compared to other cohorts. Patients with a simplex
system were more likely to have an effective first TUI than patients with duplex systems,
as were patients without preoperative reflux. Although not statistically significant,
our data suggest prior UTI, prenatal diagnosis, higher preoperative hydronephrosis
grade, and the use of electrocautery may be associated with having additional surgeries.
Keywords
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References
- Genetic Basis of Ureterocele.Curr Genomics. 2016; 17: 62-69https://doi.org/10.2174/1389202916666151014222815
- Recent advances in the management of ureteroceles in infants and children: why less may be more.Current Opinion in Urology. 2011; 21: 322-327https://doi.org/10.1097/MOU.0b013e328346d455
- Management of Ureterocele? The Search for the Holy Grail.Journal of Urology. 2015; 193: 398-399https://doi.org/10.1016/j.juro.2014.11.077
- Outcomes of Endoscopic Incision for the Treatment of Ureterocele in Children at a Single Institution.Journal of Urology. 2015; 193: 662-667https://doi.org/10.1016/j.juro.2014.08.095
- Cystoscopic transurethral incision in simplex and duplex ureteroceles—is it the definitive procedure?.Journal of Pediatric Urology. 2019; 15: 560.e1-560.e6https://doi.org/10.1016/j.jpurol.2019.07.002
- THE VALUE OF ENDOSCOPIC TREATMENT FOR URETEROCELES DURING THE NEONATAL PERIOD.The Journal of Urology. 1998; 159: 1006-1009https://doi.org/10.1016/S0022-5347(01)63821-7
- Comparison of electrocautery versus holmium laser energy source for transurethral ureterocele incision: an outcome analysis from a tertiary care institute.Lasers Med Sci. 2021; 36: 521-528https://doi.org/10.1007/s10103-020-03051-w
- Adult Bilateral Ureteroceles Presenting with Lower Urinary Tract Symptoms and Acute Urinary Retention.Case Reports in Urology. 2018; (2018)e3186060https://doi.org/10.1155/2018/3186060
- A novel approach for an old debate in management of ureterocele: long-term outcomes of double-puncture technique.Journal of Pediatric Urology. 2019; 15: 389.e1-389.e5https://doi.org/10.1016/j.jpurol.2019.04.022
- Duplex system ureterocele in infants: Should we reconsider the indications for secondary surgery after endoscopic puncture or partial nephrectomy?.Journal of Pediatric Urology. 2013; 9: 11-16https://doi.org/10.1016/j.jpurol.2012.06.016
- Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems.World J Urol. 2019; 37: 2237-2244https://doi.org/10.1007/s00345-018-2607-x
- Transurethral incision of ureterocele: Does the time of presentation affect the need for further surgical interventions?.J Pediatr Urol. 2017; 13: 501.e1-501.e6https://doi.org/10.1016/j.jpurol.2017.02.016
- A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles.J Urol. 2006; 176 (–7; discussion 1877): 1871https://doi.org/10.1016/S0022-5347(06)00601-X
- Transurethral Puncture for Ureterocele—Which Factors Dictate Outcomes?.Journal of Urology. 2010; 184: 1620-1624https://doi.org/10.1016/j.juro.2010.04.023
- The Modern Approach to Ureteroceles.Journal of Urology. 1995; 153: 166-171https://doi.org/10.1097/00005392-199501000-00068
- Obstructive ureterocele—an ongoing challenge.World J Urol. 2004; 22: 107-114https://doi.org/10.1007/s00345-004-0407-y
- Impact of de novo vesicoureteral reflux on transurethral surgery outcomes in pediatric patients with ureteroceles.Investig Clin Urol. 2019; 60: 295-302https://doi.org/10.4111/icu.2019.60.4.295
- Management of ectopic ureterocele associated with renal duplication: a comparison of partial nephrectomy and endoscopic decompression.Journal of Urology. 1999; 162: 1406-1409https://doi.org/10.1016/S0022-5347(05)68322-X
- The modern endoscopic approach to ureterocele.Journal of Urology. 2000; 163: 940-943https://doi.org/10.1016/S0022-5347(05)67857-3
- Laser-puncture Versus Electrosurgery-incision of the Ureterocele in Neonatal Patients.Urology Journal. 2018; 15: 27-32https://doi.org/10.22037/uj.v0i0.4016
- Laser-puncture of the ureterocele in neonatal patients significantly decreases an incidence of de novo vesico-ureteral reflux than electrosurgical incision.Journal of Pediatric Urology. 2021; 17: 492.e1-492.e6https://doi.org/10.1016/j.jpurol.2021.02.028
- Comparison of Endoscopic Ureterocele Decompression Techniques. Preliminary Experience—Is the Watering Can Puncture Superior?.Journal of Urology. 2011; 186: 1700-1704https://doi.org/10.1016/j.juro.2011.04.007
- Watering Can” Ureterocele Puncture Technique Leads to Decreased Rates of De Novo Vesicoureteral Reflux and Subsequent Surgery With Durable Results.Urology. 2017; 108: 161-165https://doi.org/10.1016/j.urology.2017.06.008
Article info
Publication history
Accepted:
February 22,
2023
Received in revised form:
February 20,
2023
Received:
August 24,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd on behalf of Journal of Pediatric Urology Company.
