title: Ectopic ureteroceles in duplex systems: long-term follow up and 'treatment-free' status.
abstract: OBJECTIVE
  Definitive treatment of ectopic ureterocele (EU) implies that no further surgery or prophylactic antibiotic is needed. The literature is unclear on which interventions render a child 'treatment free'.
  
  
  METHODS
  Thirty (23 female, seven male) patients presented between 1984 and 2000. Follow up ranged from 5 to 15 years (mean: 7). Presenting reasons were: urinary tract infection in 18 (16 females, two males; age: 17<6 months, one 2 years), prenatal ultrasound in 11 (seven females, four males), and renal failure in one (male, aged 3 weeks).
  
  
  RESULTS
  Treatment was as follows. No intervention, three (10%). Single procedure, eight (27%): five hemi-nephrectomy (HN), two transurethral incisions (TUI), one excision and re-implantation (E&R). Two procedures, 14 (47%): first procedure 10 TUI, 4 HN; second procedure 13 E&R, 1 TUI. Three procedures, three (10%): first 2 TUI, 1 HN; second 3 TUI; third 2 E&R, 1 HN. Four procedures, two (7%): first 2 TUI; second 1 HN, 1 TUI; third 2 TUI; fourth 2 E&R. Eight (27%) remained on prophylaxis: two had no intervention, in 4 the ectopic ureterocele was in situ after HN or TUI, and two had reflux after E&R. Twenty two (73%) came off prophylaxis (16 E&R, 4 HN, 1 TUI, 1 observation). Poorly or non-functioning upper pole moieties were left in place in 14/18 who underwent E&R.
  
  
  CONCLUSIONS
  'Treatment-free' status most often requires ureterocele excision. HN alone can be definitive, while TUI alone is so rarely. Poor or non-functioning upper pole segments can remain after E&R. Children with collapsed ureteroceles in situ often must remain on antibiotic prophylaxis. A staged approach with initial TUI, followed by E&R, was successful in definitively treating the majority.
authors.affiliation: Department of Pediatric Urology, Women & Children's Hospital of Buffalo, State University of New York at Buffalo School of Medicine & Biomedical Sciences, Buffalo, NY, USA.
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Wang
authors.forename: Saul P
authors.initials: SP
authors.lastname: Greenfield
authors.forename: Pierre
authors.initials: P
authors.lastname: Williot
authors.forename: John
authors.initials: J
authors.lastname: Rutkowski
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D011877:Radionuclide Imaging; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D013997:Time Factors; D014463:Ultrasonography; D014518:Ureterocele / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000517:prevention & control; D014563:Urodynamics / Q000502:physiology