Evolution of endoscopic management of ectopic ureterocele: a new approach.
OBJECTIVE
We report the evolution of endoscopic treatment of ectopic ureteroceles from the unroofing technique to a novel approach using concomitant ureterocele double puncture and intraureterocele fulguration. We also compare the results of different endoscopic modalities at a single center.


METHODS
We reviewed the records of 46 children with ectopic ureteroceles who were treated endoscopically between 1995 and 2005. The patients were divided into 2 main groups. Group 1 included 17 patients who underwent common endoscopic treatments, including ureterocele incision (4 patients), single ureterocele puncture (4), and single puncture with insertion of a Double-J stent (9). Group 2 included 29 children who underwent ureterocele double puncture and fulguration of the anterior and posterior walls of the collapsed ureterocele after insertion of a Double-J stent into both punctured sites. We also managed concomitant vesicoureteral reflux by endoscopic injection of tricalcium phosphate ceramic into the subureteral region.


RESULTS
Total success rates in group 1 were 0%, 25% and 33% in patients who underwent ureterocele incision, single ureterocele puncture and single puncture with insertion of a stent, respectively. Total success rate in group 2 was 90% (p<0.05). New onset vesicoureteral reflux developed in 8 patients (47%) in group 1, of which 6 were in ureterocele moieties, and in 8 patients (28%) in group 2, with none in a ureterocele moiety (p<0.01). A total of 13 patients (76%) in group 1 required open surgical intervention, compared to 3 (10%) in group 2 (p<0.05).


CONCLUSIONS
This new endoscopic approach is highly effective in the treatment of children with ectopic ureteroceles.
Kajbafzadeh
Abdolmohammad
A
Department of Urology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
Salmasi
Amirali Hassanzadeh
AH
Payabvash
Seyedmehdi
S
Arshadi
Hamid
H
Akbari
Hamid Reza
HR
Moosavi
Shahram
S
D001672:Biocompatible Materials / Q000008:administration & dosage; D002130:Calcium Phosphates / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011677:Punctures; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014518:Ureterocele / Q000601:surgery*; D014718:Vesico-Ureteral Reflux / Q000209:etiology / Q000517:prevention & control
D001672:Biocompatible Materials; D002130:Calcium Phosphates; C018392:tricalcium phosphate