Endoscopic Incision of Ureteroceles

A ureterocele is a congential cystic dilatation of the intravesical ureter and is more frequently seen in females; 80% are associated with the upper pole of a duplex system; 10% of ureteroceles are bilateral. The intravesical uretero-cele is located entirely within the bladder; the ectopic ureterocele is located at the bladder neck or within the urethra. Treatment depends on the type of ureterocele and the mode of presentation. Endoscopic incision is indicated in newborns or infants with uni- or bilateral ureteroceles and dilated and obstructed upper urinary tracts as well as in all children with urosepsis and bladder outlet obstruction. More than 50% of these patients need additional open surgery.

Operative Technique (Step by Step)

— Intraoperative antibiotic prophylaxis.

— Insert a 7.5- or 8.5-Fr urethrocystoscope with working channel.

— Identify the ureterocele, the orifices and the bladder neck.

— Insert a 3-Fr Bugbee electrode or the metal stylet of a urethral catheter.

— Make a small limited incision (»smile«) or puncture on the medial, anterior wall close to the level of the bladder neck.

— Provide a clean, full-thickness puncture of the ureterocele wall.

— When incising an ectopic ureterocele, perform the incision at the most distal part of the ureterocele to allow adequate drainage.

— Optional transurethral bladder drainage.

Tips and Tricks

— If the ureterocele is collapsed before the incision procedure started, squeeze the ipsilate-ral flank (kidney) of the child from outside to fill the ureterocele.

— Caeco-ureteroceles and sphincteric uretero-celes can be unobstructed by vertically incising the meatus and extending it above the bladder neck.

Complications

™ De novo reflux (VCUG 3 months postoperatively).

™ Persistence of obstruction.

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