Recent advances in the management of ureteroceles in infants and children:

why less may be more

Curr Opin Urol 21:322-327

Background information

• Sacculation of terminal portion of the ureter

Result from…

• Delayed canalization of ureter budPrenatal obstructioncystic dilatation bet the superficial and deep

muscle layers in trigone

• Intra-vesicle: orthotropic• Ectopics: more often(combined with other

anomaly, like duplex)

Clinical maniphestations

• Infection• Bladder outlet obstruction• Incontinence

Most patients with

hydroureteronephrosis

introduction

• Prevent the following problems:ObstructionVURUTIno incontinecne Minimal surgical demand

Endoscopic surgery

• Compared with duplex system abnormalityEndoscopic puncture rather than incision

make less reoperation rate in single system

• VUR + ureteroceleHigh rate of resolution• Non functioning upper pole do not increased

UTI risk

VUR problem

• Most of the VUR in ureterocele would spontaneous resolution by itself

• Excision and re-implantation are unnecessary• Endoscopic puncture and incision are enough

Indication suggest for obs

• Not have lower pole moiety obstruction• Not grade IV, V VUR• Not bladder outlet obstruction

conclusion

• Less would be more• Sono, VCUG, renal scan would be the tools for

surveying

• The objective view for operation may be persisting UTI in the patients