RESULTS OF URETEROCELE TREATMENT BY ENDOSCOPIC INCISION IN SINGLE AND DUPLEX SYSTEM

Skobejko-Wlodarska L1

Research Type

Clinical

Abstract Category

Paediatrics

Abstract 418
Paediatric Lower Urinary Tract Symptoms and Urinary Incontinence
Scientific Podium Short Oral Session 19
Thursday 5th September 2019
14:15 - 14:22
Hall H2
Pediatrics Retrospective Study Surgery
1.Children"s Memorial Health Institute, Dept Paediatric Urology
Presenter
L

Lidia Skobejko-Wlodarska

Links

Abstract

Hypothesis / aims of study
In the study is presented 5 years experience with the endoscopic treatment of ureterocele, to demonstrate its long-term effectiveness. . Endoscopic treatment is often recommended as the initial and definitive treatment in patients with especially in small and medium ureterocele, placed whole in the bladder, and associated with good function of kidney in single-system ureteroceles, or good function of the upper pole segment in duplex kidney.
Study design, materials and methods
In the years 2009-2015 were treated endoscopically 65 children aged from 10 days to 17 years, mean age was 32, 8 month. In total, we treated 73 uroteroceles, among which was the 24 associated with a single system and 49 with duplex kidney system. Bilateral ureterocele was found in 9 patients – 2 ureteroceles associated with a single kidney system and 7 with duplex kidney system. Recurrent infections occurred in 17 (26, 1%) patients. Hydronephrosis (sagital plane AP >10mm and megaureter > 6mm) on preoperative renal ultrasound was represented in 41(63%) patients. 37 in the duplicated collecting system (30 into the upper pole and 7 also into the lower pole) and 11 into the single collecting system. In the remaining patients we observed smaller distention of the renal pelvis and ureter. Pre-incision vesicoureteral reflux into the lower pole was seen in 14 (21,5 %) patients. The majority of ureteroceles (63%) were on the blader trigonum, 22% along the blader neck and 19% in the urethra. 49 patients underwent one incision and 16 two or three incision.
Results
Incision successfully decompressed the ureterocele in 42(64,6%) of 65 cases documented by ultrasonography records. 49 decompression was by one endoscopic incision, 15 after second  incision and one after third incision was lost. UTI persisted in 7 of 17 patients (11%). Hydronephrosis (AP >10mm and megaureter >6mm)  remained in 7 patients in duplicated system (3 into the upper pole and 6 into the lower pole) and in 10 into the single system on postoperative renal ultrasound. Postoperative voiding cystourethrogram was performed in 61 cases. Stable condition or spontaneous resolution of vesicoureteral reflux (VUR) into the lower pole was in 49 of 61 patients (75, 3 %). VUR occurred or intensified postoperatively in 12 patients. 4 VUR appear into the upper pole of a duplicated system. 4 (6%) patients underwent surgical intervention; the remaining children are under observation.
Interpretation of results
Results of endoscopic treatment are depended on very carefully patients selection
Concluding message
Our initial review shows that the endoscopic incision procedure can successfully decompresses the obstructing ureterocele and its associated hydronephrosis in selected cases. It decreases number of UTI. This technique also results in a decreased incidence of vesicoureteral reflux using a proper way of cut. Therefore, initial management by close surveillance is warranted because long term follow up show that in some appear bladder disorders including dysfunctional voiding and post void residual urine.
Disclosures
Funding without any funding or grant Clinical Trial No Subjects Human Ethics not Req'd this is a retrospective study Helsinki not Req'd this is a retrospective study Informed Consent No