Ureteropyelostomy and ureteroureterostomy

Abstract There are numerous options for managing ureteroceles associated with complete ureteral duplication. Embryologically, ureteral duplication is the result of abnormal branching of the ureteric bud off the mesonephric duct. The upper pole ureteric bud arises more proximal from the mesonephric duct relative to the lower pole ureteric bud leading to an upper pole orifice in a more caudal and medial position while the lower pole system is located more laterally, eponymously termed the Weigert-Meyer law. As a result, the upper pole is more commonly associated with ectopia or a ureterocele, while the lower pole tends to be associated with vesicoureteral reflux (VUR) due to shorter intramural tunnel length. Surgical decision-making for ureteroceles is influenced not only by a child's clinical course but also by the presence of reflux into any of the ureters and to a lesser extent by the function of the upper pole moiety, as well as surgeon and parental preference. Management goals include preservation of renal function, prevention of urinary tract infection (UTI) and obstruction, maintenance of continence, and minimizing surgical morbidity. If significant lower pole VUR is not a factor, ureteroureterostomy (UU) or ureteropyelostomy (UP) are valid reconstructive alternatives to ureterocele excision and reimplantation or ureterocele puncture.