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Ectopic ureterocele: Results of open surgical therapy in 40 patients


, : Ectopic ureterocele: Results of open surgical therapy in 40 patients. Journal of Urology 164(6): 2040-2044, December

Purpose: The treatment of ectopic ureterocele is controversial. In addition to debate on optimal therapy, discussion exists on whether there is further risk of deteriorating bladder function after extensive bladder surgery during the first year of life, which is a reason to postpone surgery. In a prospective nonrandomized trial we treated 40 patients regardless of age who had ectopic ureterocele with complete surgical reconstruction of the lower urinary tract and upper pole resection of poorly functioning upper pole moieties at referral. Excluded from study were 3 patients with only 1 affected renal moiety initially. Materials and Methods: We treated 31 female and 9 male patients 0 to 8.8 years old (mean age 2.17) at surgery for ectopic ureterocele extending into the bladder neck and urethra, including 19 younger than 1 year. Primary ureterocele excision was performed in 37 cases with reconstruction of the urethra, bladder neck and trigone, and ureteral reimplantation. Because of small ureterocele size, the ureterocele was left in situ in 3 patients, leading to secondary ureterocele removal due to obstructive voiding and urinary incontinence in 1 each. A staged procedure in 5 neonates involved primary lower urinary tract reconstruction with upper pole cutaneous ureterostomies followed by upper pole resection or ureteral reimplantation a few months later. After bladder neck reconstruction in 16 cases colposuspension was also done to create a normal vesicourethral angle. All patients underwent clinical and urodynamic evaluation at least 1.25 years after surgery (mean followup 5.59). Patients who were too young for the clinical assessment of continence by January 1999 were excluded from study. Results: All patients are continent. A secondary endoscopic procedure was required in 13 cases, including cystoscopy only in 2, scar incision near the ureteral orifice in 3, endoscopic reflux treatment in 4, ureterocele remnant resection in 2 and bladder neck incision for obstructive voiding in 2. Secondary open bladder reconstruction was performed in another case due to a diverticulum. Postoperatively only 1 or 2 uncomplicated episodes of urinary tract infection developed in 11 patients, while there were recurrent urinary tract infections in 4. In a patient with a preexisting loss of renal function a severe infection led to renal scarring. The voiding pattern was normal in 29 patients but 11 had dysfunctional voiding, including 5 with recurrent urinary tract infection. Urodynamic followup confirmed these clinical findings. Bladder capacity in these patients was relatively high at an average of 124% of expected capacity for age. We noted no statistically significant difference in followup parameters in patients who underwent surgery before and after age 1 year. Additional colposuspension in 16 patients did not result in any significant change in outcome compared with that in patients without this procedure. Conclusions: When compared with results in the literature, complete primary lower urinary tract reconstruction in patients with ectopic ureterocele appears to have better results than a staged approach with initial endoscopic treatment. Moreover, our study provides no proof that extensive reconstructive bladder surgery in neonates and infants leads to bladder function deterioration at a later age.

US$19.90

PMID: 11061921

DOI: 10.1016/s0022-5347(05)66961-3


Other references

Tchan, Y.T., 1953: Presence of Beijerinckia in Northern Australia. Beijerinckia, an acid-tolerant aerobic Nfixirig bacterium", has been isolated in lat. I9.5 degrees S: It has been found in Central Africa, South America, India and the Pacific Islands, but has not been detected outside the tropics.

Corcoran, P.; Keeley, H.S.; O'Sullivan, M.; Perry, I.J., 2004: Parasuicide and suicide in the south-west of Ireland. Suicidal behaviour has become recognised as a major public health problem. To examine hospital-treated parasuicide and suicide in the Southern and Mid-Western Health Boards. Parasuicide data were derived from independent data collection in general...

Wilson, A.P., 2000: Emerging antimicrobial resistance in the surgical compromised host. Improvements in the treatment of compromised patients have resulted in their prolonged survival in a debilitated state. Patients have repeated courses of antibiotics and become colonised with multiresistant pathogens during a stay in the intensive...

Allenspach, A.L., 1970: Histogenetic pleiotropism in the crooked neck dwarf chick embryo: degeneration of the trachea and thymus. Retrogressive analysis of the cn gene effect has been performed on crooked neck dwarf chick embryos between stages 28–38 (5–12 days). The phenocritical stage of mutant embryos studied is stage 29. Histolytic degeneration of neck tissue...

Broadbent, B.H., 1943: The influence of the third molars on the alignment of the teeth. The conclusions are drawn from cephalometric x-rays of the developmental growth of more than 1000 individuals and from the records of the Bolton study of normal development of the face in the growing child. The factual evidence collected during th...

Kalabukhov, NI.; Popkov, AF.; Serdyuk, VA.; Sheikina, NV., 1978: Adaptational peculiarities of mountain and ravine species and souslik populations. Unknown

Archer, E.J.; Brown, F.G., 1956: Concept identification as a function of task complexity and distribution of practice. Ss classified geometric patterns into 4 categories. Neither the main effect of distribution of practice nor the interaction with complexity was significant. Varying complexity by giving irrelevant information had a significant effect upon the diff...

Glish, G., 2007: Focus honoring R. Graham Cooks, recipient of the 2006 ASMS award for distinguished contribution in mass spectrometry. Journal of the American Society for Mass Spectrometry 19(2): 159-160

Liu, T.; Liu, H.; Zhang, J-Ning.; Zhu, T., 2016: Surgical Strategy for Spinal Dumbbell Tumors: A New Classification and Surgical Outcomes. One hundred and twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach. Current cla...

Bao D H., 1991: The viability enhancing activity of il 4 on normal human pbmc might relate to cd23 antigen. In this paper the influence of rIL-4 on the viability of normal human PBMC and its possible mechanism were studied. Results showed that rIL-4 sustained PBMC survival in a dose-dependent fashion. This activity might relat to CD23 antigen because rI...