title: Is endoscopic decompression of the neonatal extravesical upper pole ureterocele necessary for prevention of urinary tract infections or bladder neck obstruction?
abstract: OBJECTIVE
  It has been hypothesized that endoscopic decompression of the duplex extravesical ureterocele is necessary to prevent the complications of urinary tract infections and progressive hydronephrosis. This study was performed to test this premise.
  
  
  METHODS
  Infants younger than 2 weeks with an extravesical ureterocele associated with a duplex upper pole moiety were assigned to immediate endoscopic puncture of the ureterocele followed by antibiotic prophylaxis or antibiotic prophylaxis with plans for delayed surgical intervention. Radiographic studies and catheterized urine cultures were obtained at ages 3 and 6 months and for fever greater than 38.5C. All patients included in this study were followed through 6 months of life.
  
  
  RESULTS
  Of the patients 32 underwent endoscopic puncture of the ureterocele. Median patient age at endoscopy was 5 days (range 3 to 13). During the first 6 months of life complications developed in 4 (12%), including febrile urinary tract infections in 3 (9%) and with progressive hydronephrosis due to incomplete puncture of the ureterocele in 1 (3%). The remaining 40 patients were treated with antibiotic prophylaxis and delayed open surgery. Median time to open surgery was 3 months (range 2 to 6). During the first 6 months of life complications developed in 5 (13%), including 3 (8%) febrile urinary tract infections and progressive hydronephrosis in 2 (5%). No statistical difference was noted between the 2 treatment groups.
  
  
  CONCLUSIONS
  In patients with extravesical duplex ureteroceles neonatal complications of urinary tract infection and progressive hydronephrosis are not significantly different between those treated with immediate endoscopic decompression versus delayed open surgical intervention.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Husmann
authors.forename: W R
authors.initials: WR
authors.lastname: Strand
authors.forename: D H
authors.initials: DH
authors.lastname: Ewalt
authors.forename: S A
authors.initials: SA
authors.lastname: Kramer
mesh_terms: D019072:Antibiotic Prophylaxis; D019299:Decompression, Surgical; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000002:abnormalities; D012189:Retrospective Studies; D014518:Ureterocele / Q000601:surgery*; D018666:Ureteroscopy; D001748:Urinary Bladder Neck Obstruction / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000517:prevention & control*