Login to Access Video or Poster Abstract: MP61-18
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Introduction

We aim to present long-term outcomes of patients with ureterocele, treated by an innovative technique. To date the optimal surgical technique for ureterocele complex remains unclear and treatment options are extremely variable in this regard. These techniques mostly share major drawbacks including de novo vesicoureteral reflux (VUR) into ureterocele moiety and mandatory secondary surgery. A feasible and minimally invasive method for treatment of ureterocele using concomitant ureterocele double puncture and intraureterocele fulguration has been previously introduced (Kajbafzadeh et al. J Urol 2007; 177: 1118-23). Herein, we present long-term outcomes of this technique.

Methods

After obtaining institutional ethical approval, a retrospective chart review was performed to gather records of patients undergone this technique between 1999 and 2014. Patients with history of previous ureterocele surgery or follow up period of less than two years were excluded from the study. In this technique, after maintaining two punctures into the poles of ureterocele using the stylet of a 3Fr ureteral stent and cutting current, a Double-J stent was inserted into the both punctured sites. Afterwards, fulguration of anterior and posterior ureterocele walls at multiple sites was performed under direct vision in order to create anterior and posterior wall surface welding of urine channel.

Results

During the study period, 48 patients (51 ureteroceles) underwent this technique. From these, 31 (64.6%) patients were female. Two patients had single system ureteroceles. Three patients (6.2%) underwent bilateral ureterocele double puncture. Mean (range) age at the time of surgery was 2.9 (2 months – 13 years) years. The mean follow up period was 6.1 (2-15.2) years. Mode of presentation was febrile UTI (52%). Ureterocele was successfully decompressed in all except two kids (success rate=96%). Secondary ureterocele surgery was performed successfully in two aforementioned patients. De novo VUR was diagnosed in another two patients in upper pole ureter (one grade II, one grade III) which was endoscopically treated with success in both cases. No febrile UTI was encountered postoperatively.

Conclusions

The present study suggests that double puncture ureterocele surgery is highly successful in decompressing ureterocele without incurring major complications, further partial nephroureterectomy or common sheet double ureteric reimplatation. We believe that, this technique could serve as a promising minimally invasive alternative in ureterocele management.

Funding

none