Place du traitement endoscopique des urétérocèles compliquées de l’adulte

Abstract

Ureterocele is a congenital malformation that is rarely diagnosed in adults. Treatment is indicated for complicated or symptomatic forms, but has not been clearly standardized. The objective of this study was to evaluate the results of endoscopic meatotomy according to the Rodriguez technique. Retrospective study of 26 adult patients with ureterocele treated between Jan uarv 1987 and December 2004. The mean age of this population was 41 years and the sex ratio was 1.7/3. Thirty-two intravesical ureteroceles were diagnosed, six of which were bilateral. Eighteen ureteroceles were complicated by in situ stones, nine were complicated by moderate proximal dilatation and three presented both complications. Two ureteroceles were asymptomatic and uncomplicated, justifying conservative management. Endoscopic treatment was performed in 30 cases and consisted of a curved meatotomy with concomitant treatment of stones, when present. No operative incidents were recorded and the postoperative course was uneventful. Clinical and radiological improvement was obtained in 23 of the patients reviewed. Two of the 12 patients assessed by retrograde cystourethrography presented grade I vesicoureteric relux that had resolved at 6 months. No case of meatal stenosis was observed. Endoscopic meatotomy appears to be the treatment of choice for complicated or symptomatic ureterocele in adults. It is a minimally invasive, easy, reproducible and effective technique.