Early Endoscopic Decompression in Treatment of Pediatric Ureterocles Presenting to a Single Institution and Requirement of Secondary Procedures in these Patients

Abstract

The basic goals of treatment of ureterocele are preservation of renal function, relieving obstruction, preventing and managing reflux, and maintaining continence. Our study was mainly focussed on the role of early endoscopic decompression in these patients and need for a secondary procedure.The study was conducted as prospective study starting from January 2015 to December 2018, at the Division of Pediatric Surgery of the Sheri Kashmir Institute of Medical Sciences (SKIMS) , India. Children were either diagnosed prenatally as having ureterocele or postnatally mostly presenting as urinary tract infections . All the children with diagnosis of ureterocele at ultrasonography were included, if treated by endoscopic access. Both intravesical and extravesicalureteroceles were included.Twelve patients presented with ureterocele over a 3 year period. There were 8 girls and 4 boys. 2 patients were diagnosed prenatally and 10 in postnatal period. Average age of the patients at the time of decomporssion was 16 months. 9 patients in the study group had unilateral single system ureteroceles. 2 patients had bilateral ureterocele with one patient among them having bifid system on right side. One patient had unilateral ureterocele with a bifid system. UTI was the most common presentation .Two patients in our study required a definitive surgery (16.66%) after initial decompression. Rest of the 10 patients were strictly followed up did not require a definitive surgery. Among these 10 patients one patient had bilateral ureterocele and underwent endoscopic decompression only. 9 patients had single system unilateral ureterocele and decompression sufficed in them as a definitive treatment. Among these 9 patients two had mild degree of VUR which resolved with conservative treatment. Patients who have achieved toilet training were observed for bladder dysfunction and had none till date and are still on follow-up.We recommend edoscopic decompression as a definitive treatment in unilateral single system ureteroceles ,however a close follow-up is recommended.