Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles.

PURPOSE: We studied the clinical evolution of vesicoureteral reflux after endoscopic puncture of ureterocele in pediatric duplex systems. MATERIALS AND METHODS: We retrospectively reviewed charts of children with duplex system ureteroceles treated between 1992 and 2007. We analyzed patient age, prenatal diagnosis, urinary tract infection at presentation, differential renal function and preoperative vesicoureteral reflux. The fate of associated vesicoureteral reflux after endoscopic puncture of ureterocele was specifically addressed. RESULTS: We analyzed 60 patients with a mean age of 12 months, of whom 32 (52%) were diagnosed prenatally and 40 (66%) presented with a urinary tract infection. The majority of ureteroceles were ectopic, and pre-puncture vesicoureteral reflux was seen in 40 patients (67%). Postoperative voiding cystourethrogram was performed in 50 cases. New onset of vesicoureteral reflux occurred postoperatively in 24 patients (40%), mainly ipsilateral to the lower pole or contralaterally. Spontaneous vesicoureteral reflux resolution or improvement occurred in 16 of 22 patients (72%) observed after primary endoscopic puncture of ureterocele. Surgical intervention after endoscopic puncture of ureterocele was performed in 25 patients (42%), of whom 9 underwent more than 1 reparative procedure. CONCLUSIONS: Vesicoureteral reflux after endoscopic puncture of ureterocele may occur in the ipsilateral upper or lower poles, or in the contralateral renal segments. Therefore, the reflux is not necessarily related to the puncture itself. Vesicoureteral reflux after endoscopic puncture of ureterocele can resolve spontaneously in a significant number of patients. Therefore, initial management by close surveillance is warranted. Considering the simplicity of the procedure, our findings support that endoscopic puncture of ureterocele is an attractive alternative for the initial management of pediatric duplex system ureteroceles.

Antenatally detected ureterocele: Associated anomalies and postnatal prognosis.

OBJECTIVE: We purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients. MATERIAL AND METHODS: We reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010-March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained. RESULTS: The mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy. CONCLUSION: Ureterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.

[Ureter triplex with non-functioning upper pole due to ectopic ureterocele and refluxive third ureter bud : case report and review of the literature]. / Ureter triplex mit afunktionellem Oberpol bei ektoper Ureterozele und refluxiver dritter Ureterknospe : Fallbericht und Literaturübersicht.

We present the case of an 8-month-old boy with ureter triplication on the left side with non-functional upper pole due to ectopic ureterocele and a refluxive third ureter bud. We performed an upper pole heminephroureterectomy with resection of the ureterocele and of the refluxive third ureter bud and reimplantation of the lower pole ureter using the psoas hitch technique.

Ureterocele--a familial congenital anomaly.

Nonidentical twins with ectopic ureteroceles, and duplication of the urinary collecting system in two more members of the same family are described. This incidence may indicate that inborn anomalies of the urinary tract may have a genetic background.

Prolapse of ectopic ureterocele and bladder trigone.

The first documented case of prolapse of an ectopic ureterocele and bladder trigone is presented. The differential diagnosis and therapy are discussed.

Diagnosis of ectopic ureterocele using ultrasound.

Three children with ectopic ureteroceles were examined with ultrasound, excretory urography, and voiding cystography. In all cases the ultrasound studies outlined the ectopic ureterocele within the bladder.

Neonatal hydronephrosis: 146 cases.

Recognition and precise etiologic diagnosis of neonatal hydronephrosis is worthwhile since, although often severe, it is usually treatable with at least partial success. This relatively favorable prognosis, despite dilatation that may be marked, suggests a greater regenerative capacity at this age, or may be due to the relative infrequency or short duration of the infection.

Ureteral duplication, ectopy and ureteroceles.

These entities pose some of the most challenging diagnostic and therapeutic objectives involving the urinary system. The clinical presentations are varied, and involve children from prenatal to adolescent age groups. The diagnostic and therapeutic alternatives are presented, along with a classification for the more complex clinical settings.

Congenital segmental giant megaureter.

A case of congenital segmental giant megaureter is reported. The patient presented with an asymptomatic abdominal mass resulting from the megaureter. A mildly hydronephrotic ipsilateral kidney was palpable as a separate mass. The ureter proximal and distal to the dilated segment showed normal peristaltic activity. Treatment consisted of excision of the dilated segment, with end-to-end ureteric anastomosis.

Transurethral puncture of ureterocele associated with single collecting system in neonates.

BACKGROUND/PURPOSE: It is believed by some investigators that transurethral puncture (TUP) of single-system intravesical ureterocele (SSU) is the treatment of choice in totally asymptomatic patients who receive this diagnosis in utero, but its success depends on the incision technique and type of the uroterocele incised. METHODS: Experience with 20 SSU in 17 asymptomatic newborns detected by prenatal ultrasound scan is reviewed. TUP of the SSU was performed as treatment of choice in 12 (60%) renal units (RU). RESULTS: Decompression of the ureterocele was achieved in 100% of cases, and a vesicoureteral reflux was created in three (25%) RU. Surgery was performed in only 30% of patients who underwent TUP of the ureterocele. Our experience confirms that short (2 to 3 mm) TUP achieves decompression of the affected renal unit and that this procedure can be performed in neonates as outpatient procedure. In addition, it is often the only procedure to perform. CONCLUSION: The authors believe that TUP should be considered the treatment of choice in the management of single-system ureteroceles.

Unusual anatomic presentation of ectopic ureteroceles.

The authors describe four patients with unusual anatomic presentation of ectopic ureteroceles and their surgical treatment. Over a 3-year period, four cases of unusual ectopic ureteroceles were encountered. A 6-month-old girl had a complex cloacal anomaly with an ectopic ureterocele within the cloaca. A 10-year-old boy had two large diverticuli within an ectopic ureterocele combined with a blind-ending ipsilateral ureter. A 3-year-old girl had an ectopic ureterocele combined with a periureteral diverticulum and a completely duplicated ipsilateral kidney. A 4-year-old girl was found to have a vaginal ectopic ureterocele. Despite thorough radiological investigation in all patients, a correct assessment of the anatomic defect was achieved only by surgical exploration or endoscopic evaluation. If preoperative radiological evaluation is equivocal, a high index of suspicion and intraoperative recognition of an unusual anatomic presentation of the ectopic ureterocele are essential for appropriate management and a successful outcome.

[Endoscopic therapy of ectopic ureterocele]. / Die endoskopische Therapie der ektopen Ureterozele.

For a long time the standard treatment of an ectopic ureterocele, combined with a double collection system, was an upper-pole resection with or without ureter resection. Between 1980 and 1992, 27 children were treated initially with an endoscopic incision of the ureterocele. Twenty-four of these children were followed up. In 11 of 24 cases the endoscopic incision was sufficient and in 5 of 24 other children a reflux operation had to be performed afterwards, so that in 66% of the children the upper-pole resection was not necessary. We presume that the endoscopic incision of an ectopic ureterocele must be the first step in operative planning.

[Therapeutic concept of complicated ureterocele in childhood]. / Therapiekonzept der komplizierten Ureterozele im Kindesalter.

Because of the varied pathological manifestations of complicated ureteroceles, it is difficult to formulate a standardized management schedule. In a retrospective analysis of the methods of treatment appued in recent years, we try to determine the best procedure. Incision of the ureterocele is obsolete. Ureteroceles are often combined with renal duplication. Therefore, in small children we prefer staged surgical management with primary heminephrectomy and partial ureterectomy, with the option of avoiding later excision of the ureterocele. In older children it is advisable to perform all the treatment of the urinary tract in a single stage.

[Obstructive ectopic ureterocele: review of the literature in the light of the authors' own experience]. / Obstructiv, ectopiás ureterokele: irodalmi áttekintés, saját eseteink tükrében.

The epidemiology, clinical presentation, evaluation and methods of surgical management of ectopic ureteroceles was studied. The prenatal detection of hydronephrosis of the upper pole of duplex systems allows early surgical correction, and this effectively decreases the risk of urinary tract infection, urosepsis and irreversible loss of renal function. Yet a precise prenatal diagnosis of accompanying ureterocele is not necessary for efficient postnatal management.

[Current trends in the treatment of malformative uropathies]. / Moderni orientamenti nel trattamento delle uropatie malformative.

Urinary tract malformations are common malformations. Surgical correction is very often required to normalize the urinary tract and to prevent renal function deterioration or to ameliorate a compromised renal function. The results of the surgical management have had a considerable improvement in the last decades. Three mechanisms worked at this regard: 1) the possibility of antenatal ultrasound diagnosis; 2) a better knowledge of the natural postnatal evolution; 3) the long-term results of the surgical treatment. Referring to literature's data and especially to a wide personal experience, the Author outlines the correct indications for surgery and the most effective surgical procedures in the management of the most important urinary tract malformations.

[Surgical correction of primary nonrefluxing megaureter in children and its remote results]. / Operativnaia korrektsiia pervichnykh nerefliuksiruiushchikh form megauretera u detei i ee otdalennye rezul'taty.

Correction of primary non-reflux megaureter (153 ureters) was made in 136 patients aged 3 months to 14 years. Bilateral disease was in 17 patients. Non-reflux non-obstructive megaureter was in 113 cases, obstructive in 40 cases including association with ureterocele in 23 cases. Resection of distal ureter with its neoimplantation into the urinary bladder according to the antireflux technique was made in 146 patients, endovesical electroperforation and resection of ureterocele were made in 5 and 2 patients, respectively. Good results were obtained in 88.3% (135 ureters), satisfactory in 2.6% (4 ureters), unsatisfactory in 9.1% (14 ureters). After effective correction of megaureter, the treatment should be focused on adequate therapy of pyelonephritis present in 90% examinees, on improvement of urodynamics and stabilization of sclerotic process in renal parenchyma. The patients need long-term follow-up and more effective treatment.

Large spectrum of complete urinary collecting system duplication exemplified by cases. Pictorial essay.

Urinary collecting system duplication is a congenital anomaly and can associate various types of urinary tract pathologies. Authors will illustrate by cases some of associated anomalies such as ureterocele, extravesical ectopic ureter, vesicoureteral reflux or reflux nephropathy; one case presented an association between posterior urethral valve and bilateral collecting system duplication.

Neonatal osteomyelitis and complex nephro-ureteral duplication.

OBJECTIVE: This report presents a case of femoral osteomyelitis secondary to urinary tract infection in a female neonate with bilateral urinary duplication and right ectopic ureterocele. METHODS: A female neonate with a history of late perinatal sepsis presented to the emergency department and was found to have left distal femoral osteomyelitis. A complex urological malformation was diagnosed (bilateral renal duplication with right ectopic ureterocele associated with nonfunctional superior pole of the ipsilateral kidney). The baby was submitted to prolonged antibiotic therapy and upper pole nephrectomy of the right kidney. RESULTS: The pathology report confirmed chronic pyelonephritis and dysplasia in the resected specimen. After 1.5 years the patient is asymptomatic and developing normally, with no apparent deformity, but manifests asymptomatic vesicoureteral reflux. CONCLUSIONS: Urinary tract infections must always be excluded as the primary infection focus in neonates with sepsis. Perinatal osteomyelitis is almost always a complication of neonatal sepsis and is associated with orthopedic sequelae. This is the first report in literature of a case of osteomyelitis complicating complex urinary duplication and urinary tract infection.