Therapeutic approach to ureterocele cases (Clinical experience of 10 years)

Materials and Methods: A total of 26 children who treated for ureterocele between 2000 and 2010 were investigated.Results: Fifteen were girl and 11 were boy. Mean age was 2.4 years (7 days-14 years). Five patients had antenatal diagnosis, while 10 presented with UTI, 4 with abdominal pain, 3 with urethral prolapsus of ureterocele, 2 with dificulty in voiding, one hematuri, and one incidentaly diagnosed. Renal damage was present in 21 patiants. Three patients had additional pathology (two ureteral Stone, one bladder fistula). Overall, 11 patients developed VUR. As the primary intervention, endoscopic puncture was performed on 15 patients, endoscopic insicion on 10, and open ureterocele exision and ureteral reimplantation one one patient. During the follow-up period, 3 patients required ureteral reimplantation due to persisten reflux and UTI, while 6 required parcial nephrectomy due to UTI breaktrough and nonfunctioning upper pole. At the last follow-up, 18 patients were free of symptom, 4 lost the follow-up, two had reflux, and died.Conclusions: Ureterocele is mostly associated with duplex system. UTI is the most common symptom presented with ureterocele; one of the most important cause of renal damage is UTI that occur when there is a delay in diagnosis and treatment. Therefore, early diagnosis and treatment may decrease permenant renal damage. Endoscopic decompression of ureterocele which is minimaly invasive, simple, safe and has a high success rate, should be the first modality of choice in the surgical treatment of children with ureterocele. This procedure is sufficient by itself in the majority of such patients. However, partial nephrectomy should be the second choice of treatment in children with recurrent UTI and no improvement of nonfunctioning upper pole.Key Words: Children, Ureterocele, Treatment