Endoscopic management of ureteroceles in children. Commentary

Objective: Treatment of ureteroceles in children varies according to the anatomicopathological form and the choice of the surgical team. This study tries to determine the exact value of the endoscopic management of ureteroceles in children. Methods: Between 1987 and 1993, 11 ureteroceles in 10 children were treated by endoscopic incision: 7 intravesical ureteroceles (4 single system and 3 duplex system) and 4 duplex-system ectopic ureteroceles. The procedure consists of a tiny transversal incision at the lower and median aspects of the ureterocele. Results: The dilation of the upper urinary tract disappeared or decreased in all cases of intravesical ureteroceles and in half the cases of ectopic ureteroceles. Endoscopic incision of the ureterocele led to a vesicoureteral reflux in the associated ureter in 6 cases: 54.5% (43% of the intravesical ureteroceles, 75% of the ectopic ureteroceles). Following endoscopic treatment, no further surgery was required in 5 of the 7 cases with intravesical ureteroceles (71.5%), while every case of ectopic ureterocele needed a further operation (lower tract surgery in 3 cases, upper tract surgery in I case). Conclusions: Endoscopic incision of ureteroceles is a simple and quick procedure which allows obstruction to be removed and the dilation of the upper urinary tract and its corresponding kidney function to be improved, particularly in the neonate. The endoscopic management of ureteroceles may in itself suffice, without necessity of further surgery. These favorable results can more readily be seen in cases of intravesical ureterocele than in those of ectopic ureterocele.