ureterocele

1. Recent advances in the management of
ureteroceles in infants and children:
why less may be more
Curr Opin Urol 21:322-327

2. Background information
• Sacculation of terminal portion of the
ureter

3. Result from…
• Delayed canalization of ureter bud
Prenatal obstruction
cystic dilatation bet the superficial and deep
muscle layers in trigone
• Intra-vesicle: orthotropic
• Ectopics: more often(combined with other
anomaly, like duplex)

4. Clinical maniphestations
• Infection
• Bladder outlet obstruction
• Incontinence
Most patients with
hydroureteronephrosis

5. introduction
• Prevent the following problems:
Obstruction
VUR
UTI
no incontinecne
Minimal surgical demand

6. Endoscopic surgery
• Compared with duplex system abnormality
Endoscopic puncture rather than incision
make less reoperation rate in single system
• VUR + ureterocele
High rate of resolution
• Non functioning upper pole do not increased
UTI risk

7. VUR problem
• Most of the VUR in ureterocele would
spontaneous resolution by itself
• Excision and re-implantation are unnecessary
• Endoscopic puncture and incision are enough

8. Indication suggest for obs
• Not have lower pole moiety obstruction
• Not grade IV, V VUR
• Not bladder outlet obstruction

9. conclusion
• Less would be more
• Sono, VCUG, renal scan would be the tools for
surveying
• The objective view for operation may be
persisting UTI in the patients