title: Transurethral incision of duplex system ureteroceles in neonates: does it increase the need for secondary surgery in intravesical and ectopic cases?
abstract: OBJECTIVE
  To evaluate the relevance of ureterocele ectopia and associated reflux on the outcome of duplex system ureteroceles (DSU) after neonatal transurethral incision (TUI).
  
  
  METHODS
  The study included 41 neonates with a diagnosis of DSU; the ureterocele was ectopic in 24 (58%). Before TUI, vesico-ureteric reflux (VUR) was present in 13 lower moieties (32%) and seven contralateral ureters (17%). TUI was always performed within the first month of life. The follow-up and management were tailored for each patient from the findings at ultrasonography, voiding cysto-urethrography and renal scintigraphy. Results of intravesical and ectopic DSU were compared using Fisher's exact test.
  
  
  RESULTS
  TUI was effective in allowing ureteric decompression in all but one patient (2.4%). After TUI, VUR ceased in six lower ipsilateral moieties and in two contralateral ureters, while new VUR occurred in three contralateral kidneys. De novo VUR in the punctured moiety appeared in 13 cases (32%). Nine upper poles were not functioning. Twenty-one patients (51%) required secondary surgery. Ureteric reimplantation was indicated exclusively for reflux in the punctured moiety in only in two cases (5%), while in a further two iatrogenic reflux in a nonfunctioning upper moiety required total heminephro-ureterectomy. There was no significant difference between intravesical and ectopic ureteroceles in the occurrence of VUR in the punctured moiety, rate of nonfunctioning upper poles or need for secondary surgery.
  
  
  CONCLUSIONS
  About half of the patients with a DSU need secondary surgery, but this is rarely indicated for de novo reflux in the punctured moiety only. The need for secondary surgery was greater whenever there was associated reflux before endoscopic incision. There was no difference in the outcome of intravesical and ectopic ureteroceles and such distinction seems no longer to be of clinical relevance.
authors.affiliation: E. Albanese Hospital, Paediatric Surgery Unit, University of Palermo, Palermo, Italy. marcocastagnetti@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Castagnetti
authors.forename: M
authors.initials: M
authors.lastname: Cimador
authors.forename: M
authors.initials: M
authors.lastname: Sergio
authors.forename: E
authors.initials: E
authors.lastname: de Grazia
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D012086:Reoperation; D016216:Ultrasonography, Prenatal; D014518:Ureterocele / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000473:pathology