Surgical Management of Ureteroceles in Children: Strategy Based on the Classification of Ureteral Hiatus and the Eversion of Ureteroceles

Experience in the surgical management of ureterocelesin children is reported. Six patients with intravesical and 16 with ectopic ureteroceles are included. In the case of intravesical ureterocele of noneverting type, transurethral distal incision of the ureterocele was performed without reflux. In the case of everting ureterocele, excision with reimplantation of the ureter was performed, thus avoiding reflux inevitably induced by transurethral incision. In the patient with an ectopic ureterocele, a one-stage operation with complete excision of the ureterocele and ureteral stump was attempted. Our choice of operative procedure was decided after the assessment of the following features: cystography and cystoscopy to assess eversion, type of ureteral hiatus (common or separate), whether there was reflux or not to the ipsilateral ureter, and renal function by scintigraphy. Accordingly, heminephroureterectomy or twin ureteroneocystostomy were most commonly performed. When based on these thorough preoperative evaluations, our results were quite favorable.