Transurethral incision as initial option in treatment guidelines for ectopic ureteroceles associated with duplex systems
Treatment strategies for children with ectopic ureteroceles (EUs) and duplex collecting systems or vesicoureteral reflux are controversial. Transurethral incision (TUI) of EUs associated with duplex systems has been considered only as a temporizing technique. This study aimed to evaluate whether primary TUIs could be considered as an initial treatment option in EUs with duplex systems.
Materials and methods
Forty-seven children with EUs associated with duplex systems underwent primary TUIs at our institution between November 2007 and October 2017. We retrospectively analyzed patient characteristics such as age, sex, upper tract status, ureterocele location, differential renal function, and preoperative vesicoureteral reflux with regard to postoperative complications requiring additional surgery, postoperative incontinence, and renal function.
The mean age at operation was 4.8 ± 4.7 months. Of the 47 patients, 26 (55.3%) underwent primary TUIs only, 3 (6.4%) underwent secondary TUIs, and 18 (38.3%) underwent other secondary procedures such as common-sheath reimplantation (CSR) and ureterocelectomy. Secondary surgeries in 21/47 (44.7%) patients occurred during a mean follow-up of 47.7 ± 23.3 months, and the most common type of secondary surgery was CSR. The most common reason for secondary surgery was febrile urinary tract infection (14/21 patients [66.7%]). There were three cases (3/26 [11.5%]) of voiding problems after primary TUI and two cases (2/15 [13.4%]) after secondary CSR.
Primary TUIs should be considered as initial treatment options for EUs in duplex systems and not just a temporizing technique.
KeywordsEctopic ureterocele Transurethral incision Duplex system
The authors would like to thank Dong-Su Jang, MFA, (Medical Illustrator) for his help with the illustrations.
JSP: project development, data analysis, and manuscript writing/editing. YSL: project development, data analysis, and manuscript editing. CNL: data collection. SHK: data collection. SWK: project development and data analysis. HL: data collection. SWH: project development, data analysis, and manuscript editing.
Compliance with ethical standards
Conflict of interest
All of the authors declare that they have no conflicts of interest.
All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was not required for the purposes of this study, as it was based upon retrospective anonymous patient data and did not involve patient intervention or the use of human tissue samples.
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