Ureteroceles are congenital cystic dilations of the intravesical submucosal ureter. They are more commonly found in female children and are almost exclusively diagnosed in Caucasians. Approximately 10% of these children have bilateral ureteroceles. Ureteroceles may be orthotopic (contained entirely within the bladder) or ectopic (partially situated at the bladder neck or urethra). An orthotopic ureterocele is typically associated with a single collecting system, whereas an ectopic ureterocele is usually associated with the upper pole moiety of a kidney with complete ureteral duplication.


The goals of surgical treatment should be the preservation of renal function, elimination of obstruction and reflux, prevention or elimination of infection, and maintenance of urinary continence while minimizing surgical morbidity (3). The main factors to consider in developing an individual treatment plan should be patient age, patient’s clinical presentation, ureterocele size and anatomy, presence of reflux and UTI, and function of the involved renal segment.


The anatomy and clinical presentations of children with ureteroceles vary widely. Therefore, each child should have an individualized treatment plan, as no single method of surgical repair is appropriate for all cases. Table 94.1 lists some therapeutic options for patients with ureteroceles.


Techniques that preserve functional upper pole moieties are listed in the following sections. However, in many instances, the upper pole has little to no contribution to the overall renal function and upper pole ablative techniques, also described in the following sections, may be indicated.


Upper pole preservation

Endoscopic incision of the ureterocele

Complete lower tract reconstruction (excision of ureterocele with ureteral reimplantation)


Upper pole ablation

Upper tract approach (upper pole nephrectomy and partial ureterectomy)

Complete reconstruction (concomitant upper and lower urinary tract surgery)

Upper Pole Preservation

Endoscopic Incision of the Ureterocele

The goal of endoscopic incision of ureteroceles is to decompress the ureterocele in a minimally invasive manner while minimizing the risk of postincision vesicoureteral reflux and the need for further urinary tract reconstruction (4). This technique can be used in infants, if infant-sized endoscopic equipment is available, and should be used to drain obstructive urinary systems in any ureterocele patient with urosepsis. Blyth and coauthors (5) recommended the use of a 3Fr Bugbee wire electrode (using the cutting current) to incise the roof of the ureterocele through its full thickness near its base and proximal to the bladder neck. A new unobstructed intravesical ureteral orifice will be created, and the roof of the collapsed ureterocele can act as a flap-valve mechanism to prevent reflux. Although the Bugbee electrode has been a widely used instrument for ureterocele puncture, it has limitations, primarily that following initial decompression enlargement of the puncture site is difficult. Therefore, we prefer to use the pediatric resectoscope and the right-angle hook electrode with the cutting current, which allows one to make a clean transverse incision and enlarge it by placing the hook into the original incision and withdrawing under vision (Fig. 94.2). Magnification with the use of video projection helps improve the accuracy of the incision. Making the incision as distal and as close to the bladder neck as possible should reduce the risk of postoperative reflux into the corresponding ureter. The adequacy of the incision can be confirmed by the presence of a jet of urine from the ureterocele or by visualization of the urothelium inside the ureterocele. The major advantage of the endoscopic incision is that it can be done on an outpatient basis without the need for hospitalization. Other energy sources, such as a laser, have also been described as an alternative method of endoscopic incision (6).

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Apr 24, 2020 | Posted by in UROLOGY | Comments Off on Ureteroceles

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