title: Long-term bladder function after ureterocele decompression in children.
abstract: OBJECTIVE
  There is limited knowledge of long-term bladder function after ureterocele decompression. We studied bladder function in patients who underwent surgery in childhood for duplex system ureteroceles.
  
  
  METHODS
  Toilet trained children treated for duplex system ureteroceles between 1990 and 2010 were included in study. We evaluated voiding dysfunction by the valid DVSS questionnaire and noninvasive studies, including uroflowmetry, electromyogram and post-void residual urine measurement. Urodynamics were done only in patients with abnormal DVSS or abnormal noninvasive studies. Patients were divided into group 1-ureterocele decompression (endoscopic incision), upper pole partial nephrectomy and ureteropelvic anastomosis, and group 2-primary or secondary bladder surgery (ureterocelectomy, ureterovesical reimplantation and bladder floor reconstruction).
  
  
  RESULTS
  Of 62 operated patients 17 were lost to followup and 45 were fully studied at a mean followup of 9.5 years (range 3 to 20). Initial surgery was done at mean age of 5.1 months (range 6 days to 48 months). In the 33 group 1 patients, of whom 70% underwent endoscopic incision, the mean DVSS score was 1.5 (range 0 to 6), 7 patients (22%) had abnormal uroflowmetry or significant post-void residual urine and none had abnormal DVSS results. In the 12 patients in group 2 the mean DVSS score was 4 (range 0 to 11), 8 patients (66%) had abnormal uroflowmetry and significant post-void residual urine, and 3 had abnormal DVSS findings (p = 0.036). All group 2 patients underwent bladder surgery after decompression, including endoscopic incision in 2 and upper pole partial nephrectomy in 1. Only 1 child needed clean intermittent catheterization at age 3 years for hypocontractile megacystis and repeat febrile urinary tract infections.
  
  
  CONCLUSIONS
  Ureterocele decompression alone in early childhood does not lead to major bladder dysfunction at long-term evaluation. Even if secondary bladder surgery is needed, significant bladder dysfunction is rare.
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors: Annabel
authors: A
authors: Paye-Jaouen
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors: Filippo
authors: F
authors: Pistolesi
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors: Nathalie
authors: N
authors: Botto
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors: Goharig
authors: G
authors: Enezian
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors: Christine
authors: C
authors: Grapin-Dagorno
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors: Matthieu
authors: M
authors: Peycelon
authors: Department of Pediatric Surgery and Urology, Robert-Debré University Hospital, Assistance-Publique Hôpitaux de Paris, Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: alaa.elghoneimi@rdb.aphp.fr.
authors: Alaa
authors: A
authors: El-Ghoneimi
mesh_terms: D002648:Child; D019299:Decompression, Surgical; D004724:Endoscopy; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D014518:Ureterocele / Q000503:physiopathology / Q000601:surgery*; D001743:Urinary Bladder / Q000503:physiopathology*; D014555:Urination Disorders / Q000209:etiology*; D014563:Urodynamics
keywords: congenital abnormalities; lower urinary tract symptoms; ureterocele; urinary bladder; urinary tract infections