This document discusses ectopic ureters and ureteroceles. Some key points:
1. Ectopic ureters and ureteroceles are congenital abnormalities that occur due to abnormal development of the ureter and urinary tract.
2. Clinical presentations can include urinary tract infections, incontinence, pain, and obstruction. Evaluation involves ultrasound, voiding cystourethrogram, nuclear scans, and possibly MRI.
3. Management depends on factors like obstruction, reflux, and renal function. Options include observation, acute decompression, definitive surgery like reimplantation, and in some cases total reconstruction or upper pole nephrectomy. Complications
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
A Case Presentation and relative topic review regarding ureterocele and duplicated collecting system during my clerkship in Image Diagnostic Department
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
El 10% de la población las padece.
Constituyen el 45% de los casos de insuficiencia renal crónica de la infancia.
Frecuentemente tienen bases hereditarias y están asociadas a anomalías de otros sistemas.
Predisponen a las infecciones recurrentes y a la urolitiásis del tracto urinario.
Unas no tienen significación clínica y otras producen problemas para la salud y pueden comprometer la vida del paciente.
El pronóstico está ensombrecido por el retraso en conocer la anomalía en edades tempranas
A Case Presentation and relative topic review regarding ureterocele and duplicated collecting system during my clerkship in Image Diagnostic Department
Dr Ho Siew Hong shared his experience on how to perform the ideal puncture for PCNL in a lecture to Asian urologists during the Advanced Urology Course 2008 in Singapore
El 10% de la población las padece.
Constituyen el 45% de los casos de insuficiencia renal crónica de la infancia.
Frecuentemente tienen bases hereditarias y están asociadas a anomalías de otros sistemas.
Predisponen a las infecciones recurrentes y a la urolitiásis del tracto urinario.
Unas no tienen significación clínica y otras producen problemas para la salud y pueden comprometer la vida del paciente.
El pronóstico está ensombrecido por el retraso en conocer la anomalía en edades tempranas
Presentación realizada por el Dr. Juan Carlos Vázquez García, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Dr. Federico Navarrete. Módulo Tórax.
R2 Imagenología Diagnóstica
Tema relevante en el estudio de pacientes con Cirrosis.
Basado en artículo de Radiographics.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
Presentación realizada por el Dr. Cesar Augusto Herrera Méndez, R1 de la especialidad de Imagenología Diagnostica y Terapéutica del Hospital Regional de Alta Especialidad de la Península de Yucatán.
By using transvaginal sonography, the bladder can be seen as early as 11 weeks of gestation. By 12 to 13 weeks, the bladder is visualized in 98% of cases using both transabdominal and transvaginal sonography.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
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Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
2. INTRODUCTION
Ureteral duplication:
Most common congenital renal abnormality.
Found in 1% population & 10% of children diagnosed
with UTIs.
Incomplete ureteral duplication- one common
ureter enters bladder, rarely clinically significant.
Complete ureteral duplication- two ureters
ipsilaterally enter the bladder.
3. Propensity for VUR into lower pole and
obstruction of upper pole.
Upper-pole ureter may be ectopic in its insertion into
bladder or may end in a ureterocele.
Both conditions are more common in duplicated
collecting systems but may also be seen in single
systems.
4. Ectopic ureter & Ureterocele:
Distinct entities, but share many common features.
Same underlying developmental mechanisms.
A continuum of embryologic development.
Similar clinical presentations.
Approached in a similar manner.
Slight variation in management.
5. DEFINITION
Ectopic ureter:
Any ureter, single or duplex, that does not enter
trigonal area of bladder.
In a duplex system, inevitably upper pole ureter,
because of its budding from mesonephric duct later
than lower pole with later incorporation into the
developing urogenital sinus.
6. In females, entry anywhere from bladder neck to
perineum and into vagina, uterus, and even rectum.
May be a/w dilated Gartner duct cyst (Wolffian duct
remnant from which ureter buds)→ Rupture →
vaginal communication→ incontinence.
In males, entry always above external sphincter or
pelvic floor, usually into wolffian structures,
including vas deferens, seminal vesicles, or
ejaculatory duct.
No incontinence, but infection and pain of affected
organs (testicles and epididymis).
8. Retrograde injection study
of boy with abdominal
pain and a ureterocele
associated with a
hypoplastic right
kidney. The intravesical
ureterocele (UC) is being
injected and demonstrates
communication with
the right seminal vesicle
(arrowhead) and vas
deferens (arrows), with
the ureter (UR) leading to
the dysplastic kidney. At
surgical resection, the
ureter and vas joined just
above the seminal vesicles
9. Single-system ectopic ureters & ureteroceles →
apparently absent kidney on USG → small, poorly-
functioning renal unit on CT Urogram.
Rare B/L single-system ectopic ureters may be a/w
hypoplastic bladder & B/L renal
abnormalities/dysplasia (apparent bladder agenesis).
10. Ureterocele:
Cystic dilatation of terminal intravesical ureter.
Intravesical ureterocele- entirely contained within
the bladder; may prolapse into urethra during
voiding.
Ectopic ureterocele- if any portion is permanently
situated at bladder neck or urethra, regardless of the
position of orifice(bladder, bladder neck or urethra).
Do not form entirely within urethra, nor do they
attach to wolffian ductal structures.
Single or duplex system, and in duplex systems
invariably affects upper pole.
13. A, Sphincterostenotic ectopic ureterocele.
B, Cecoureterocele lumen extends distal to the orifice as a long tongue
beneath the ureteral submucosa. The orifice communicates with the
lumen of the bladder and is large and incompetent.
14. Churchill’s Functional classification system:
based on impact of ureterocele on upper urinary
tract, including all renal units.
1. Only upper pole affected, 2. Entire ipsilateral
kidney involved, & 3. Contralateral system also at
risk d/t reflux or B.O.O.
15. Non-obstructive ureterocele with duplication or
“Ureterocele disproportion”:
A/w a duplex kidney, but affected upper pole &
ureter non-dilated and dysplastic→ not readily
detected on most imaging.
Typical ureterocele seen in bladder, but ipsilateral
kidney completely normal.
17. PATHOPHYSIOLOGY & EMBRYOLOGY
Ureteral bud branch from mesonephric/Wolffian duct
Extends into nephrogenic blastema(undifferentiated
mesenchyma)
Formation of the entire renal collecting system
Distal to ureteric bud, mesonephric duct incorporates into
UGS
U.O. superolaterally moves to its normal position on
trigone
18. Distal segment of mesonephric duct is carried
inferomedially→incorporated into bladder neck.
In male fetus, it also develops into seminal vesicle, vas
deferens, and epididymis.
In females, it becomes Gartner duct, located between
vagina and urethra.
19. In ureteral duplication, two ureteric buds arise from
mesonephric duct.
Lower - earlier insertion into UGS & superolateral
location of orifice; poor trigonal support & short
intramural tunnel → predisposed to VUR.
Upper- inserts later & low on trigone inferomedially
→ inserts ectopically at bladder neck, ejaculatory
duct, seminal vesicle, or vas deferens in males & in
Gartner duct in females.
20. Ureteral ectopia without duplication result from
delayed incorporation of distal ureter into
developing bladder.
Ureterocele development- two theories: 1. failure of
Chwalle membrane to break down at the distal
ureter during development -results in obstruction
and saccular dilation. 2. Aberrant signaling from
expanding urogenital sinus results in dilation of
distal ureter.
21. EPIDEMIOLOGY
Incidence of ureteral duplication- 1% (autopsy series).
Ureteroceles- 1 per 5000-12000 population; 10%
bilateral, 60-80% ectopic, 80% a/w upper-pole ureter
of a duplex system. Single system ureteroceles a/w
cardiac & genital anomalies.
More common in females.
More common in whites.
22. PRENATAL IMAGING DETECTION
Majority of ectopic ureters & ureteroceles detected
on prenatal USG, even if no specific diagnosis.
Duplex system prenatal Dx difficult, except in dilated
upper moiety.
Upper pole “cyst” in a fetus – upper pole
hydronephrosis until proven otherwise.
Bladder inspection mandatory to identify ureterocele
in all cases- wait for bladder filling.
Character of upper pole parenchyma- thickness &
echogenicity.
23. A large ectopic ureter may impinge on the bladder appear
as intravesical structure, “Pseudoureterocele.”
Careful evaluation of other renal units & bladder.
Ipsilateral lower pole or contralateral dilation suggests
reflux or less commonly obstruction from ureterocele or
dilated ectopic ureter.
B.O.O. by a ureterocele can manifest as hydronephrosis of
all renal units.
Oligohydramnios, contralateral renal dysplasia- rare.
Prenatal intervention or early delivery- no benefit.
24. CLINICAL PRESENTATION
INCIDENTAL:
Significant HN with an ectopic ureter or ureterocele.
During evaluation for cause of general abdominal
pain.
Cases of presumed ovarian cysts may be markedly
dilated ureters.
25. INFECTION:
UTI in first few months of life- MC presentation.
Generalised urosepsis d/t infected obstructed system.
Ongoing low-grade fever with periodic spikes.
Purulent discharge from the perineum
Bacterial epididymitis/orchitis- recurrent episodes.
26. INCONTINENCE:
Caused by an ectopic ureter in a girl, but never in boys.
Persistent low-volume dampness at all time; Child
can’t remain dry for even 30-60 min.
Diagnosis difficult before toilet training.
Rare pts.- intermittent leakage through a Gartner duct
membrane.
Untreated ureteroceles not a/w incontinence.
27. PAIN: Uncommonly a/w acute infection, episodic
obstruction of ectopic ureter or bladder pain caused
by an obstructing ureterocele.
PROLAPSE: Ureterocele prolapse unusual; smooth,
congested, mucosa covered interlabial masses
protruding from urethra; non-circumferential, non-
lobulated.
LATE PRESENTATION: Infection,
abdominal/flank pain, Incontinence, Stone in
ureterocele.
31. EVALUATION
PHYSICAL EXAMINATION:
May facilitate diagnosis.
Prolapsed ureterocele, ectopic perineal ureteral
orifice in a child with H/O continuous dampness
Dilated Gartner duct cyst- rare.
Palpable dilated upper pole of ectopic ureter or
ureterocele in a relaxed infant.
32. Perineal ectopic ureteral orifice (bottom arrow) cannulated with an angiocatheter,
situated
between the urethral orifice (top arrow) and the vagina, just to the left of midline
33. A, Gartner duct cyst (bottom right arrow) in newborn with a left multicystic dysplastic
kidney. B, Injection of the cyst communicated with the ureter and dysplastic kidney.
34. ULTRASOUND:
Typical findings-dilated upper pole with ureteral
dilation or dilated single system.
Bladder images differentiate ureterocele from ectopic
ureter- thin-walled cystic dilation within the bladder,
not extending beyond its walls.
36. Ultrasound demonstrating dilated upper pole (UP) and lower pole (LP) associated with a
ureterocele. The upper pole has evident renal parenchyma. The lower pole is dilated because of
compression of the dilated upper pole ureter on the lower pole system, creating a partial obstruction.
37. Ultrasound image of dilated upper pole (UP) associated with a
ureterocele, demonstrating limited renal parenchyma
39. MRI:
Provides most detailed imaging.
Currently reseved for patients with distorted,
complex anatomy.
Added advantage- functional information.
40. RENAL FUNCTION- NUCLEAR IMAGING:
Gold standard for renal functional assessment- DMSA.
Prime role- function of affected upper pole, also status of
other renal moieties, if lower pole reflux of HN of any unit.
To assess drainage function in ureteroceles in which
Observation is planned- Diuretic renal scan replaces DMSA-
provides both funvtional & drainage information.
IVU:
Less useful baseline study.
Functional assessment only qualitative.
Ureterocele- a "cobra head" or "spring onion"
configuration at bladder level.
43. VOIDING CYSTOURETHROGRAM (VCUG):
Most definitive test for bladder,distal ureters &urethra.
Obligatory to define baseline situation before any
intervention.
Omitted in emergency TUI for ureterocele producing
BOO, urosepsis or B/L upper tract obstruction.
Duplicated collecting systems with lower-pole reflux &
nonrefluxing upper pole, give appearance of a
"drooping lily“.
45. VCUG of duplex system ureterocele with reflux into
lower moiety
ureterocele
Reflux into lower moiety
Everting
ureterocele
46. Voiding cystourethrogram image of a cecoureterocele where the ureterocele
(black arrow) is attached to the urethra (white arrow) and the lumen extends
into the urethra
48. REFLUX:
Reflux of ipsilateral lower pole – 50%.
Contralateral reflux in 25% of cases, and
Reflux into ureterocele in 10% of cases.
In an ectopic ureter, ipsilateral lower pole reflux is
unlikely to resolve spontaneously.
49. ENDOSCOPIC EVALUATION:
Assess character of urethra, bladder neck and trigone
relative to ureterocele or ectopic ureter.
Location of other ureteral orifices should be documented.
Orifice of affected ureter should be sought but may not be
identified.
Urethra is examined carefully for orifice if not seen in
bladder.
Appearance of ureterocele will vary with bladder filling;
start with little filling and slowly increase bladder volume.
Lowest portion – best site for incision.
Retrograde contrast can confirm ureterocele disproportion
& unusual connections with genital ducts.
50.
51. CLINICAL MANAGEMENT
Before intervention, obtain maximum information
about pts’ altered anatomy & physiology.
No criteria to decide how much upper pole renal
function in worth preseving.
MANAGEMENT GOALS:
1. Preservation of renal function;
2. Elimination of infection, obstruction, and reflux;
3. Maintenance of urinary continence; and
4. Minimizing surgical morbidity.
52. ACUTE DECOMPRESSION:
Indications:
Ureterocele producing BOO or severe B/L upper tract
obstruction.
Severe urosepsis.
Sepsis not responding to appropriate therapy.
Methods:
For ureteroceles- Transurethral Incision (TUI).
For ectopic ureters- end ureterostomy near bladder.
53. DEFINITIVE SURGICAL OPTIONS:
For Ectopic ureter- common sheath
reimplantation or ureteroureterostomy, either
low/distal or high proximal near the renal pelvis.
For Ureterocele- TUI, ureterocele excision and
common sheath reimplantation or
ureteroureterostomy.
54. OBSERVATIONAL MANAGEMENT:
Non-operative management of ureteroceles meeting
certain criteria, in carefully selected pt.& parental
education-
1. no obstruction of ipsilateral lower pole or
contralateral kidney,
2. limited reflux to lower pole (grade III or less),
3. no function of upper pole, or
4. no obstruction on diuretic renography.
Potential for later unpredictable acute presentation.
55. TOTAL RECONSTRUCTION:
Upper pole nephrectomy with ureterocele excision
and reimplantation of lower pole ureter is definitive
but extensive operation performed with two
incisions.
Ideal candidate- older child with a massive
ureterocele and no function of an upper pole with
significant lower pole reflux.
56. UPPER POLE PARTIAL OR HEMI-
NEPHRECTOMY:
Preferred treatment when no function in the upper pole.
Open surgery conventional laparoscopy, Robotic
laparoscopy, Laparoendoscopic single-site
surgery(LESS) nephrectomy.
Results in ureteroceles with/without lower pole reflux:
resolution- 20%, New reflux- 15-50%, secondary surgery
rate- 40-50%.
58. Surgical management of the
refluxing ureteral stump.
A It is difficult to completely
separate the distal 2 to 3 cm
of upper pole ureter from
lower pole ureter. The ectopic
ureter is excised to this point.
B The outer wall of ectopic
ureter is excised to the
bladder level.
C A transfixing suture
obliterates its lumen, with
care being taken not to injure
the orthotopic ureter.
59. COMPLICATIONS OF UPPER POLAR
NEPHRECTOMY:
1. Loss of lower pole function,
2. Postoperative upper pole urinoma
3. IVC laceration,
4. Duodenal perforation,
5. Total nephrectomy,
6. Peritoneal tears.
60. LOWER TRACT RECONSTRUCTION:
A definitive reconstruction at bladder is suitable for
both ectopic ureter and ureterocele.
Advantage: relieving obstruction as well as
correcting reflux.
Disadvantages: potential for injury to bladder neck
and vagina, complexity of the procedure.
If clinically significant reflux persists after other
procedures, lower tract reconstruction may be
necessary.
61. Results:Very good.
Persisting reflux-
5-10%, more
common when
ureteral tapering
done.
62. PYELOURETEROSTOMY &
URETEROURETEROSTOMY:
When upper pole of an ectopic ureter or ureterocele is preserved
owing to function or surgeon preference.
Anastomosis between upper pole ureter & lower pole ureter in
an end-to-side fashion. Proximal & distal approaches used.
Proximal anastomoses preferable to a distal
ureteroureterostomy with a dilated upper pole, because the
latter may result in more urinary stasis .
63. TRANSURETHRAL INCISION (TUI):
Transverse incision through full thickness of
ureterocele wall using cutting current, as distally &
close to the bladder floor as possible.
Bugbee electrode, angled-tip wire, Cold knife,
resectoscope with Collins hot knife, Laser incision.
Deep incision to incise thick wall, see for urine-jet or
inner urothelium.
Ectopic ureterocele:Longitudinal incision from
intravesical into urethral portion, or two incisions.
64. No catheter required.
Follow-up USG after 4-6 weeks to assess degree of
decompression.
VCUG at 2-3 months to determine status of lower
pole reflux.
Risk of reoperation high with extravesical
ureteroceles & lower pole reflux (persisting or new).
65. TEMPORARY END URETEROSTOMY FOR
ECTOPIC URETER:
Ectopic ureter in infant with sepsis or massive
dilation.
Advantage- Acute decompression to manage sepsis
and permit later assessment(in 4 mths or 6 mths
age) of any function in affected renal unit before
definitive management.
66. CLINICAL DECISION MAKING
ECTOPIC URETERS:
Duplex System
Single System
Preservation or
Excision (based
on function &
Surgeon
preference)
Lower pole
reflux
No reflux
Proximal or
distal
uretero-
ureterostomy
Reflux
Common sheath
reimplantation or
lower pole
reimplantation with
distal upper to lower
ureteroureterostomy
Massively dilated ureter
Temporary end
ureterostomy
68. URETEROCELE:
TUI reasonable to offer before more complex
reconstructions, specially young infants.
May make a subsequent surgical procedure less
complex by decompressing a dilated upper pole
ureter. Reimplantation may be much more effective
and not require excisional tapering.
Older child with a massive upper pole, removal &
definitive surgery perform at diagnosis.