title: Long-term followup of endoscopic incision of ureteroceles: intravesical versus extravesical.
abstract: OBJECTIVE
  Endoscopic incision was performed as the initial therapy for ureteroceles in children presenting to our institutions between 1985 and 1990. To assess the long-term efficacy of this treatment modality we reevaluated the outcome of these patients.
  
  
  METHODS
  Parameters reviewed included patient age at surgery, position of the ureterocele, a duplex system, preoperative and postoperative reflux, and the need for additional operations. Statistical analysis consisted of chi-square and Wilcoxon's rank sum tests.
  
  
  RESULTS
  Of the patients 22 had intravesical and 22 had extravesical ureteroceles. Average age at initial surgery was 1.9 +/- 3.7 years with average followup of 7.2 +/- 3.1 years. A second operation was required in 18 cases (41%), which was significantly more likely for an extravesical ureterocele (18% versus 64%, p = 0. 002), a duplex system (p = 0.026) or preoperative reflux (p = 0.02). Second operations included reimplantation in 13 cases, upper pole partial nephrectomy in 7, total nephroureterectomy in 3, bladder neck reconstruction in 3 and lower pole pyeloplasty in 3. The only secondary operations performed for intravesical ureteroceles were reimplantation in 3 cases and upper pole nephrectomy in 1. New onset reflux developed in 14 of 27 patients (52%) postoperatively, including 7 with intravesical and 7 with extravesical ureteroceles. None required a second open operation.
  
  
  CONCLUSIONS
  With extended followup the percentage of patients requiring open surgery after endoscopic incision of ureteroceles increased from our original report of 27% to 41% (p = 0.166). Only 18% of cases with an intravesical ureterocele required a subsequent operation compared to 64% with an extravesical ureterocele (p = 0.002). The reduction in size of the obstructed ureter following endoscopic decompression facilitated successful reimplantation. Endoscopic puncture permits definitive treatment in the majority of children by at most a single incision, open operation at the bladder level.
authors.affiliation: Division of Pediatric Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Cooper
authors.forename: G
authors.initials: G
authors.lastname: Passerini-Glazel
authors.forename: J C
authors.initials: JC
authors.lastname: Hutcheson
authors.forename: M
authors.initials: M
authors.lastname: Iafrate
authors.forename: C
authors.initials: C
authors.lastname: Camuffo
authors.forename: C
authors.initials: C
authors.lastname: Milani
authors.forename: H M
authors.initials: HM
authors.lastname: Snyder
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D012092:Replantation; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery; D014518:Ureterocele / Q000601:surgery*; D018666:Ureteroscopy; D014718:Vesico-Ureteral Reflux / Q000209:etiology