Comparison of Endoscopic Ureterocele Decompression Techniques. Preliminary Experience—Is the Watering Can Puncture Superior?

Abstract

The optimal endoscopic technique to manage an obstructing ureterocele would reliably relieve obstruction without creating de novo vesicoureteral reflux. The classic incision achieves decompression but invariably creates new vesicoureteral reflux. We compared a new endoscopic puncture technique to assess its superiority to endoscopic incision. We retrospectively reviewed 27 consecutive endoscopic ureterocele procedures at our institution. Patients who underwent an endoscopic incision or watering can puncture procedure had their records reviewed for preoperative radiological and clinical data, operative description, and postoperative radiological and clinical outcomes. Of the 15 patients with endoscopic ureterocele incision 11 underwent a watering can puncture. All ureteroceles were associated with grade 3 or 4 hydronephrosis. Incision successfully decompressed the ureterocele in 14 of 16 cases (87.5%) and hydronephrosis in 14 (87.5%) on postoperative renal ultrasound. De novo reflux was detected in 12 of 16 patients (75.0%) on postoperative voiding cystourethrogram. Puncture successfully decompressed the ureterocele in 10 of 11 cases (90.9%) and hydronephrosis in 9 (81.8%). De novo vesicoureteral reflux was detected in 4 of 11 patients (36.4%). Our initial review shows that the endoscopic watering can procedure successfully decompresses the obstructing ureterocele and its associated hydronephrosis. This technique also results in a decreased incidence of de novo vesicoureteral reflux and ultimately in fewer invasive procedures for the patient.