First-line Treatment Modality in Children with Complete Duplicating System Complicated with Ureterocele or Ectopic Ureter: Ureteropyelostomy.
- Author:
Ho Sung CHOI
1
;
Ok Hyun CHIN
;
Sang Won HAN
Author Information
1. Department of Urology, Yonsei University College of Medicine, Seoul, Korea. swhan@yumc.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
Duplicated collecting system;
Ectopic ureter;
Ureterocele;
Ureteropyelostomy
- MeSH:
Bacteriuria;
Child*;
Follow-Up Studies;
Humans;
Hydronephrosis;
Technetium Tc 99m Dimercaptosuccinic Acid;
Ultrasonography;
Ureter*;
Ureteral Obstruction;
Ureterocele*;
Urinary Bladder
- From:Korean Journal of Urology
2002;43(8):667-671
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.
