URETEROCELE DISPROPORTION REVISITED

• Published in: Pediatrics (Evanston) 1999-09, Vol.104 (3), p.854-854
• Main Authors: Park, John M, Lebowitz, Robert L, Bauer, Stuart B, Diamond, David A, Peters, Craig A, Atala, Anthony, Retik, Alan B
• Format: Article
• Language: English
• Subjects: Pediatrics
• ISSN: 0031-4005

Introduction: In most situations, an ectopic ureterocele is associated with hydroureteronephrosis of the upper pole of a double collecting system. We have previously described a clinical entity-non-obstructive ureterocele-in which an ectopic ureterocele exists without the typical ureteral and calyceal dilatation (JJ Urol 119:804, 1978) and called it ureterocele disproportion (UD) (Am J Radiol 152:567, 1989). Because the typical urographic and sonographic signs of an ectopic ureterocele are either subtle or absent, the presence of UD may be missed until the time of surgery. We reviewed our recent experience with UD. Patients and Methods: We identified 18 patients (14 girls) with the diagnosis of UD treated at our hospital since 1986. Their ages at the time of presentation ranged from newborn to 5 years. Ten patients were evaluated because of prenatal hydronephrosis. The remainder presented following urinary tract infection. All patients underwent sonography, voiding cystourethrography and excretory urography. UD was suspected when there was no visible upper pole (or no upper pole dilatation) in association with an ipsilateral ureterocele. In all patients, direct opacification of the ureterocele (accomplished at the time of surgery by puncture and injection of contrast agent) confirmed the diagnosis. Results: All patients demonstrated vesicoureteral reflux into the ipsilateral lower pole. The appearance of the diminutive upper pole ureter ranged from a completely occluded "cord-like" structure to a non-dilated ureter connected to a tiny dysplastic upper pole. Four UD's were connected to upper pole multicystic dysplastic kidneys. Transurethral incision (TUI) of the ureterocele was the initial treatment in ten patients, while ureterocele excision and common sheath ureteral reimplantation were performed as the initial treatment in seven. One asymptomatic patient has been followed without surgery for 4 years. In the TUI group, four had resolution of the lower pole reflux and required no further treatment, while six needed additional surgery to correct persistent lower pole reflux. No patient developed upper pole reflux after TUI. All patients who required secondary surgery after the initial TUI had other problems including paraureteral diverticulum (4), large ureterocele eversion (1), and poor renal function of the lower pole (1), whereas four patients who were successfully treated with TUI alone had only lower pole reflux. Conclusions: The presence of ureteroce