[Acute urinary retention secondary to giant prolapsed ureterocele in a young adult woman. Case report].
Villagómez-Camargo Roberto,Chopin-Gazga Marco,Saucedo-Bravo Jonathan,García-Cano Eugenio,Montiel-Jarquín Álvaro
Cirugia y cirujanos
BACKGROUND:Ureterocele is a cystic dilation of the distal ureteral segment. The incidence in women ranges from 1/5,000 to 1/12,000. In adults, they are poorly diagnosed and are asymptomatic. Prolapse through the urethra is uncommon, and involves acute urine retention and a reducible vulvar tumour. CLINICAL CASE:Woman of 24 years old, two previous caesarean and two abortions. She had incomplete bladder emptying, intermittent voiding, bladder straining and tenesmus, three months before admission. After the voiding effort she presented with acute urine retention with sudden onset of tumour in the vulva. The tumour was manually reduced under regional anaesthesia. A cystoscopy was performed, finding an ischaemic de-roofing of the anterior wall of the ureterocele, causing vesicoureteral reflux grade IV. Surgical correction was performed with Cohen re-implantation and insertion of a double-J catheter. The catheter was removed 30 days later, with a successful post-operative course. DISCUSSION:Its aetiology is unclear, and most are diagnosed by ultrasound in the prenatal period. The clinical presentation is variable, from urinary tract infection to prolapse. Despite its size, it may cause complications such as ischaemic de-roofing, which if diagnosed soon may be resolved successfully, as with this patient. CONCLUSION:The results and treatment may be favourable when no renal impact or concomitant anatomical changes are present, as is the case of this patient.
Outcomes of endoscopic incision for the treatment of ureterocele in children at a single institution.
Sander James C,Bilgutay Aylin N,Stanasel Irina,Koh Chester J,Janzen Nicolette,Gonzales Edmond T,Roth David R,Seth Abhishek
The Journal of urology
PURPOSE:We assessed outcomes in children with ureterocele after transurethral incision at our institution between 2001 and 2014, focusing on end points of vesicoureteral reflux, improvement of hydronephrosis and need for second surgery. MATERIALS AND METHODS:We performed chart reviews of 83 patients, collecting information including age at transurethral incision, gender, renal anatomy, ureterocele location, indication for transurethral incision, and preincision and postincision vesicoureteral reflux and hydronephrosis status. Patients were divided into those with single system and duplex system ureteroceles, and intravesical and extravesical location for analysis. Statistical evaluations were performed with the Wilcoxon rank test and Fisher exact test. RESULTS:Transurethral incision was performed at a mean age of 34.2 months in patients with single system ureterocele and 8.9 months in those with duplex system ureterocele (p <0.0001). Cure rates (improvement of hydronephrosis and absence of vesicoureteral reflux) were 55.6% in patients with single system ureterocele and 14.9% in those with duplex system ureterocele (p = 0.0031). Rates of de novo reflux into the ureterocele moiety were 27.8% for patients with single system ureterocele and 56.2% for those with duplex system ureterocele (p = 0.0773). Patients with single system ureterocele required significantly fewer second surgeries (3.8%) than those with duplex system ureterocele (73.7%, p <0.0001). CONCLUSIONS:Patients with single system ureterocele may benefit from endoscopic incision. Transurethral incision was definitive in all such patients except 1 in our study. Although most patients with duplex system ureterocele will need a second operation, transurethral incision remains of value in this population in instances of sepsis or bladder outlet obstruction, or to facilitate planned reconstruction when the child is older.
Giant hydronephrosis in a case of ureterocele with duplex system: an entity yet not reported.
Aeron Ruchir,Sokhal Ashok Kumar,Kumar Manoj,Sankhwar Satyanarayan
BMJ case reports
Ureterocele, which is a cystic dilatation of the terminal ureter, is usually associated with the upper moiety in a case of the duplex system. Giant hydronephrosis, a rare entity, is usually due to pelviureteric junction obstruction and is usually diagnosed in infants and children. We report a unique case of a unilateral complete duplex system with ureterocele with giant hydronephrosis of the upper moiety in an adult woman presenting as an abdominal lump. To the best of our knowledge, this is the first case of giant hydronephrosis associated with ureterocele in an adult patient.
Ureterocele fenestration with holmium laser in neonates.
Ilic Predrag,Jankovic Mirjana,Milickovic Maja,Dzambasanovic Slobodan,Kojovic Vladimir
Annali italiani di chirurgia
AIM:To evaluate the effectiveness of holmium-laser fenestration of intravesical ureteroceles in neonatal period. MATERIAL AND METHOD:We retrospectively analyzed the results of the holmium-laser puncture in ten neonates with intravesical ureterocele, between September 2013 and September 2016. Laser probe was placed through the cystoscope to the lowest and medial portion of the ureterocele, near the bladder floor. Few punctures (4 to 8) were made, until ureterocele has been collapsed. RESULTS:Mean duration of general anesthesia was 16 minutes (range, 10-24) and duration of hospitalization was 1-3 days (mean, 1.3 days). There weren't complications regarding endoscopic treatment. There was the need for retreatment in one (10%) patient. Obstruction was found in one (10%) patient on ultrasound after one month. After three months there was no obstruction on ultrasound in any patient. In patients in whom VCUG was performed, vesicoureteral reflux was not found three months after the surgery. DISCUSSION:The relief of the obstruction, prevention of the vesicoureteral reflux and the urinary tract infection are the reasons for the immediate treatment in the neonatal period. In that way, the preservation of renal function is enabled. The reason for laser fenestration was better endoscopic control of the extensibility of the ablation. The moment of ureterocele collapsing can be visualized directly. CONCLUSIONS:Holmium-laser fenestration is a minimally invasive, highly effective and safe kind of treatment for ureterocele in neonatal period with minimal complication rate. Further clinical studies with a greater number of patients will offer more reliable information regarding this procedure. KEY WORDS:Fenestration, Holmium-laser, Neonates, Ureterocele.
Transurethral incision of ureterocele: Does the time of presentation affect the need for further surgical interventions?
Hodhod A,Jednak R,Khriguian J,El-Sherbiny M
Journal of pediatric urology
OBJECTIVES:Ureterocele management is considered to be one of the famous debates in pediatric urology. Despite some considering transurethral ureterocele incision (TUI) as a temporary line of treatment, others have reported good results in terms of being a definitive treatment. The present study evaluated the feasibility of TUI as a definitive line of management. Moreover, it studied the impact of presentation on the outcomes. PATIENTS AND METHODS:The charts of patients who had ureteroceles from 1995 to 2015 were retrospectively reviewed. Patients who had undergone initial TUI were included. The initial presentation and timing were recorded. All ultrasounds, voiding cystourethrograms (VCUG) and dimercaptosuccinic acid scans (DMSA) pre-TUI and post-TUI were reviewed. Moreover, the occurrence of febrile urinary tract infections (FUTI) and any secondary surgical intervention were recorded. RESULTS (FIG. A): A total of 51 patients with 53 ureteroceles were included. Of these, 51% presented antenatally, while others had FUTI at the time of presentation. Thirty-nine ureteroceles were associated with duplex system ureterocele (DSU), while the remaining ones had single system ureterocele (SSU). The median follow-up was 44 months. The incidence of de-novo reflux into ureterocele was 44% of SSU and 23% of DSU (P = 0.22). Reflux into ureterocele after TUI (four SSU and seven DSU) carried a high risk of surgical interventions (3/4 SSU and 6/7 DSU). Hydronephrosis was improved in 64% of both DSU and SSU patients. Secondary surgery was performed in 51% of DSU and 35.7% of SSU. Twelve patients (67%) presented postnatally with DSU and had subsequent interventions after incision in comparison with 38% (eight patients) of those who presented antenatally. The DSU had improved renal function (by DMSA) in 26%, while the remaining had stable renal function. DISCUSSION:All patients with delayed ureterocele presentation had FUTI, while 1/3 of antenatally presenting patients had FUTI during follow-up. Notably, the age at subsequent interventions was apparently the same despite different ages at presentation. Study limitations included the retrospective chart review. Additionally, the pre-operative and postoperative investigations, such as laboratory and radiological results, were present and reviewed in most, but not all, patients. CONCLUSION:Two thirds of SSU and approximately half DSU patients had no surgical intervention after TUI. However, those who presented antenatally had a lower risk of FUTI and lesser probability of being re-operated. VUR into ureterocele, regardless the system duplicity, had a high re-operation rate. After ureterocele incision, 26% of DSU patients had renal function improvement.
Endoscopic meatotomy in the treatment of ureterocele: results in adult patients.
Oueslati Amine,Saadi Ahmed,Chakroun Marouene,Zaghbib Selim,Bouzouita Abderrazak,Derouiche Amine,Slama Mohamed Riadh Ben,Ayed Haroun,Chebil Mohamed
The Pan African medical journal
To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a "smiling mouth" meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate.
The left ureterocele and stone of calyceal diverticulum in the patient with bilateral incomplete duplex kidneys managed by flexible ureteroscopy: a case report and literature review.
Pan Yang,Chen Gang,Chen Han,Zhu Yunxiao,Chen Hualin
BACKGROUND:Duplex kidneys are one of the most common renal congenital abnormalities, mostly asymptomatic and of no clinical significance. There are little reports about the left ureterocele and stone of calyceal diverticulum in patients with bilateral incomplete duplex kidneys managed by flexible ureteroscopy. CASE PRESENTATION:A 69-year-old Chinese woman was presented with left waist pain for 1 month. A preoperative computed tomography (CT) scan and intravenous pyelogram revealed the left ureterocele which located in the left ureterovesical junction, and stone of calyceal diverticulum which located in the upper kidney of left incomplete duplex kidneys. The ureterocele was confirmed in view of ureteroscopy and the holmium laser was used for the resection of ureterocele. It took us a lot of efforts to find out the stone because of diverticular neck stenosis. Fortunately, when diverticular neck stenosis was incised internally by holmium laser, the stone was discovered clearly and removed using the holmium laser and nitinol stone basket through flexible ureteroscopy. A double-J ureteral stent was inserted and remained in place for 1 month. The symptom disappeared postoperatively and no complications were developed during the placement of the stent. There were no stone residents observed on CT scan before removing the ureteral stent 1 month later. CONCLUSIONS:Flexible ureteroscopy with holmium laser is feasible to manage the ureterocele and calyceal diverticulum stones in patients with bilateral incomplete duplex kidneys in one operation.