MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES?

Abstract

You have accessJournal of UrologyPediatric Urology IV (MP51)1 Sep 2021MP51-09 ROLE OF NON-OPERATIVE MANAGEMENT OF URETEROCELES: SHOULD WE PUNCTURE ALL URETEROCELES? Aznive Aghababian, Sameer Mittal, Sahar Eftekharzadeh, John Weaver, Katherine Fischer, Christopher Long, Dana Weiss, Jason Van Batavia, Mark Zaontz, Thomas Kolon, Stephen Zderic, Douglas Canning, Aseem Shukla, and Arun Srinivasan Aznive AghababianAznive Aghababian More articles by this author , Sameer MittalSameer Mittal More articles by this author , Sahar EftekharzadehSahar Eftekharzadeh More articles by this author , John WeaverJohn Weaver More articles by this author , Katherine FischerKatherine Fischer More articles by this author , Christopher LongChristopher Long More articles by this author , Dana WeissDana Weiss More articles by this author , Jason Van BataviaJason Van Batavia More articles by this author , Mark ZaontzMark Zaontz More articles by this author , Thomas KolonThomas Kolon More articles by this author , Stephen ZdericStephen Zderic More articles by this author , Douglas CanningDouglas Canning More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , and Arun SrinivasanArun Srinivasan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002077.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The optimal management for ureteroceles has long been under debate, due to the anatomic variability and severity of this entity. Treatment strategies range from upper pole heminephrectomy or major bladder reconstruction, to isolated endoscopic incision. We hypothesize that a carefully selected group of ureteroceles can be successfully managed without surgical intervention. METHODS: We retrospectively reviewed medical records of all patients with a diagnosis of ureterocele who were managed at our institution from 2010-2019. Patients were categorized into two groups: non-surgical management and surgical management. Non-surgical management included those who had at least 6-month follow-up with no interventions including ureterocele puncture. We analyzed baseline demographics, clinical presentation, imaging details, history of urinary tract infection (UTI), and if any procedures were performed during the follow-up period. RESULTS: We identified 240 ureteroceles in 231 patients: 56 (23%) were managed without immediate puncture and 184 (77%) surgically. Patients who underwent non-puncture management were more likely to have an intravesical ureterocele, ipsilateral multi-cystic dysplastic kidney, and were unlikely to have hydronephrosis and/or reflux on the ipsilateral side. Of 56 patients in the non-incision cohort, 6 (10%) required surgery after a median observation of 2.5 years (IQR 2.1-4.5), with 4 ureteroceles associated with a duplex system (3 intravesical and 1 ectopic) and the other 2 associated with absent kidney and an ectopic insertion. The remaining 50 (90%) did not require any surgical intervention during a median follow-up of 2.4 years (IQR 0.9-4.6). In the cohort of 50 patients who did not undergo intervention, 35 (70%) were on antibiotic prophylaxis, and febrile UTIs occurred in 12 (24%) patients from this group. Multivariate regression analysis showed that intravesical ureteroceles were more likely to be successfully managed non-operatively than ectopic ureteroceles (OR: 103.6, 95% CI: 1.4–733.5). CONCLUSIONS: Children with ureteroceles without evidence of obstruction, and/or functional renal tissue can be successfully managed without puncturing the ureterocele. An intravesical ureterocele in these children may be a predictor of success. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e899-e899 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aznive Aghababian More articles by this author Sameer Mittal More articles by this author Sahar Eftekharzadeh More articles by this author John Weaver More articles by this author Katherine Fischer More articles by this author Christopher Long More articles by this author Dana Weiss More articles by this author Jason Van Batavia More articles by this author Mark Zaontz More articles by this author Thomas Kolon More articles by this author Stephen Zderic More articles by this author Douglas Canning More articles by this author Aseem Shukla More articles by this author Arun Srinivasan More articles by this author Expand All Advertisement PDF downloadLoading ...