title: Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles.
abstract: OBJECTIVE
  We studied the clinical evolution of vesicoureteral reflux after endoscopic puncture of ureterocele in pediatric duplex systems.
  
  
  METHODS
  We retrospectively reviewed charts of children with duplex system ureteroceles treated between 1992 and 2007. We analyzed patient age, prenatal diagnosis, urinary tract infection at presentation, differential renal function and preoperative vesicoureteral reflux. The fate of associated vesicoureteral reflux after endoscopic puncture of ureterocele was specifically addressed.
  
  
  RESULTS
  We analyzed 60 patients with a mean age of 12 months, of whom 32 (52%) were diagnosed prenatally and 40 (66%) presented with a urinary tract infection. The majority of ureteroceles were ectopic, and pre-puncture vesicoureteral reflux was seen in 40 patients (67%). Postoperative voiding cystourethrogram was performed in 50 cases. New onset of vesicoureteral reflux occurred postoperatively in 24 patients (40%), mainly ipsilateral to the lower pole or contralaterally. Spontaneous vesicoureteral reflux resolution or improvement occurred in 16 of 22 patients (72%) observed after primary endoscopic puncture of ureterocele. Surgical intervention after endoscopic puncture of ureterocele was performed in 25 patients (42%), of whom 9 underwent more than 1 reparative procedure.
  
  
  CONCLUSIONS
  Vesicoureteral reflux after endoscopic puncture of ureterocele may occur in the ipsilateral upper or lower poles, or in the contralateral renal segments. Therefore, the reflux is not necessarily related to the puncture itself. Vesicoureteral reflux after endoscopic puncture of ureterocele can resolve spontaneously in a significant number of patients. Therefore, initial management by close surveillance is warranted. Considering the simplicity of the procedure, our findings support that endoscopic puncture of ureterocele is an attractive alternative for the initial management of pediatric duplex system ureteroceles.
authors.affiliation: Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisieux E
authors.initials: LE
authors.lastname: Jesus
authors.forename: Walid A
authors.initials: WA
authors.lastname: Farhat
authors.forename: Antonio C M
authors.initials: AC
authors.lastname: Amarante
authors.forename: Rafaella B
authors.initials: RB
authors.lastname: Dini
authors.forename: Bruno
authors.initials: B
authors.lastname: Leslie
authors.forename: Darius J
authors.initials: DJ
authors.lastname: Bägli
authors.forename: Armando J
authors.initials: AJ
authors.lastname: Lorenzo
authors.forename: Joao L
authors.initials: JL
authors.lastname: Pippi Salle
mesh_terms: D004724:Endoscopy; D006801:Humans; D007223:Infant; D011183:Postoperative Complications; D014518:Ureterocele / Q000150:complications / Q000151:congenital / Q000601:surgery; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery