Endoscopic Treatment of Vesicoureteral Reflux Associated With Ureterocele

Abstract

We determined the value of endoscopic treatment for vesicoureteral reflux associated with ureterocele. From 1984 to 2005, 109 children with a median age of 6 months underwent endoscopic ureterocele puncture. Ureterocele presented as a part of a duplex system in 97 of patients (89%) and as part of a single system in 12 (11%). Vesicoureteral reflux was seen to the lower ipsilateral moiety in 53 patients and in 32 contralateral kidneys (85 refluxing renal units). Puncture was performed with a 3Fr Bugbee electrode. High grade vesicoureteral reflux or breakthrough infection while on antibiotic prophylaxis served as the indication for the surgical correction of vesicoureteral reflux. Median followup after endoscopic correction was 10 years (range 1 to 21). Spontaneous vesicoureteral reflux resolution following successful ureterocele puncture was seen in 36 of the 85 refluxing renal units (42%) and in 5 (6%) reflux was downgraded. The latter patients were withdrawn from antibiotic prophylaxis and they did well. A total of 33 refluxing renal units with vesicoureteral reflux into the lower moiety of the ureterocele kidney and 11 contralateral refluxing renal units underwent endoscopic correction. Reflux was corrected in 31 of the 44 refluxing renal units (70%) after a single injection and it resolved after a second injection in another 9 (21%). In 4 refluxing renal units (9%) endoscopic correction failed and open reimplantation was done. Of the 109 patients (13%) 14 had vesicoureteral reflux to the ureterocele moiety following endoscopic puncture. Of those patients endoscopic correction resolved reflux in 3, reflux resolved spontaneously in 5 and upper pole partial nephrectomy was performed in 4 due to a nonfunctioning moiety. The remaining 2 patients did well without antibiotic prophylaxis. Our data show that endoscopic treatment of vesicoureteral reflux associated with ureterocele is a simple, long-term effective and safe procedure, avoiding the need for open surgery in the majority of patients following endoscopic puncture of ureterocele.