Incision Of Ureterocele Research Articles

Retrograde incision from orifice (RIO) technique for endoscopic incision of ureterocele: 15 years of outcomes

Management of obstructing ureterocele often includes endoscopic transurethral incision (TUI) that can be challenging secondary to uncertainty in anatomic landmarks with risk of serious complications. To this end, we innovated a technique using predictable landmarks that begins endoscopic incision at the ureterocele orifice and extends retrograde proximal to the bladder neck (Figure). With over 15 years of experience in performing this retrograde incision from orifice (RIO) technique, we aimed to examine post-operative outcomes and risk of surgical failure after RIO compared to traditional TUI techniques for ureteroceles. We hypothesized that clinical outcomes after RIO would be superior to traditional endoscopic approaches to decompression of obstructing ureterocele in infants. A retrospective study of patients ≤12 months old who underwent TUI ureterocele at our institution between 2007 and -2021 was conducted. Pre-, intra- and post-operative characteristics were compared between patients who underwent RIO vs non-RIO TUI. Primary outcome was post-incision febrile urinary tract infection (fUTI). Secondary outcome was a composite failure measure of fUTI, secondary surgery, de novo bladder outlet obstruction, or vesicoureteral reflux. Multivariable Cox proportional hazard models were fitted to compare the time-to-event risk of primary and secondary outcomes between groups. Ninety patients with 92 ureteroceles were included (49 RIO, 43 non-RIO). Median follow-up from TUI was 33 months. RIO had a shorter median operative duration (27 vs 35min, p=0.021). Primary and secondary outcomes were similar between groups (fUTI: 29% RIO vs 19% non-RIO, p=0.27; composite failure 54% RIO vs 69% non-RIO, p=0.15). In multivariable Cox proportional hazard models, there was no significant difference in risk of fUTI (RIO aHR 0.98, 95% CI 0.38-2.54, p=0.97) or composite failure (RIO aHR 0.80, 95% CI 0.45-1.44, p=0.46) between TUI techniques. RIO technique for TUI ureterocele is attractive in that it uses predictable anatomic landmarks making it simple to perform. In analyzing this 15-year institutional experience of TUI ureterocele, RIO showed similar success to non-RIO endoscopic incisions. This study is a retrospective, non-randomized, single-institutional study over 15 years and is therefore subject to change in surgeon practice over time and variable practices between providers. Given comparable success and durability over time to other TUI ureterocele techniques, and with the advantage of operator ease using consistent anatomic landmarks, RIO is a worthy option for endoscopic ureterocele decompression.

Is lower urinary tract surgery without upper pole heminephrectomy safe and effective in the long-term treatment of duplex system ureterocele?

Objective: The study aimed to retrospectively evaluate postoperative results of patients with duplex system ureterocele (DSU) who underwent endoscopic ureterocele incision (UI), lower urinary tract reconstruction (LUTR) or both, and investigate the necessity of upper pole heminephrectomy (UPH) in ureterocele treatment. Patients and methods: In total, 44 patients with DSU who were operated on in December 2005 and December 2018 were evaluated for patient characteristics, ureterocele location, differential renal function (DRF), vesicoureteral reflux (VUR), postoperative incontinence, proteinuria, hypertension and urinary tract infection (UTI). Results: UI was performed in 27 of 44 cases (61.3%) as the first-line treatment. Ten of them (37%) had no urinary infection or renal function loss at a mean of 3 years (1.5–7 years). LUTR was needed in 17 patients after UI due to VUR in 14 patients and bladder outlet obstruction (BOO) in 3 patients. In total, 34 patients who underwent LUTR, proteinuria or incontinence were not detected in the mean 6 years’ follow-up. Thirty-three patients (97%) had identical renal scans and similar DRF before and after the operation. No patient underwent UPH. Conclusion: UI must be considered the first-line treatment in DSU in infancy. In older patients, especially with VUR, LUTR is effective and safe and UPH mostly is not necessary. Level of evidence: 4

Ectopic ureterocele

Ectopic ureterocele

Laparoscopic Upper-pole Heminephrectomy for the Management of Duplex Kidney: Outcomes of a Multicenter Cohort

ObjectiveTo analyze the outcomes of patients undergoing upper-pole heminephrectomy surgery and to assess the different variables that may have an impact on outcome, specifically regarding morbidity and the need for further surgeries. Materials and MethodsA retrospective study of patients who underwent laparoscopic upper-pole heminephrectomy for a nonfunctional moiety between August 2007 and December 2019 was conducted at 3 centers. A total of 130 patients met the inclusion criteria. A transperitoneal approach was used. The following variables were evaluated: (1) preoperative: presentation, presence of ureterocele and history of ureterocele incision, hydronephrosis grade, presence of vesicoureteral reflux (VUR), and differential renal function (DRF) on renal scintigraphy; and (2) postoperative outcomes: Doppler ultrasound, renal scintigraphy, complications, febrile urinary tract infection, lower urinary tract symptoms, and need for further surgery. Findings were considered statistically significant at P <.05. ResultsPostoperative complications were observed in 5 patients (3.8%). Six patients (4.6%) needed further surgeries after heminephrectomy. The presence of ureterocele and VUR was related with the need for further surgeries odds ratio (OR) 4.91, P = .0415) and the occurrence of postoperative febrile urinary tract infection (OR 2.81, P = .0376). A 13.9% incidence of lower urinary tract symptoms was found with no difference between patients with ureterocele and those with an ectopic ureter. Renal scintigraphy showed a median decrease in DRF of 2.7%. No patient had complete loss of function. ConclusionLaparoscopic upper-pole heminephrectomy showed to be a feasible and safe procedure. In most patients this surgery will be the definitive procedure. Patients with both VUR and ureterocele will need special consideration. No significant loss of function in the remaining lower moiety was found.

Effectiveness of endoscopic treatment of duplex system ureteroceles in children

Objective. The aim of this study is to evaluate the efficiency of transurethral incision of ureteroceles and incidence of vesicoureteral reflux in pediatric patients with duplex system ureterocele.&#x0D; Materials and methods. This is a retrospective study of 155 pediatric patients with duplex system ureterocele. The age of patients at the time of surgery ranged from 5 days to 17 years (median 8.0 months). Intravesical ureterocele had 108 patients (69.8%), extravesical 47 (30.2%).&#x0D; Results. Complications occurred in 2 patients (1.3%), recurrence obstruction was in 1 case (0.6%). Ipsilateral vesicoureteral reflux after surgery had 112 patients (72.3%): in the upper pole 51 cases (32.9%), in the lower pole 32 (20.6%), in both ureters 29 (18.7%). In the long-term period after transurethral incision of ureteroceles 97 patients (62.5%) needed reoperation due to infection and voiding dysfunction. Statistically significant risk factors associated with the need for reoperation were the presence of vesicoureteral reflux on the ureteroceles side and non-functioning upper pole of the kidney.&#x0D; Conclusion. Transurethral incision of ureteroceles for duplex system ureterocele is a safe and effective minimally invasive method of primary resolving of the obstruction. Vesicoureteral reflux on the ureterocele side after surgery had 72.3% of patients; reoperation in the long term was necessary in 62.5% cases. The main risk factor reoperation is vesicoureteral reflux on the ureterocele side.

Double trouble: diagnostic dilemma in a rare association of proximal ureteric valve with orthotopic ureterocele\u2014case report

BackgroundAssociation of the ureterocele and proximal ureteral valve is a rare congenital anomaly which can lead to quick detoriation of renal function due to double obstruction. Though ureteral valves have been associated with other ureteral anomalies, this specific association is extremely rare.Case presentationA 7-month-old boy was referred to us for antenatally detected hydronephrosis. Provisional diagnosis of orthotopic ureterocele with pelviureteric junction (PUJ) obstruction was made based on preoperative imaging. Endoscopic incision of ureterocele was done and retrograde pyelography showed tight obstruction at PUJ which necessitated a pyeloplasty. Examination of resected specimen confirmed a ureteral valve. Postoperatively, the patient had good improvement in kidney function.ConclusionTo conclude, congenital ureteral valves are a rare cause of ureteric obstruction and its association with ureterocele is rarer still. Identification of an ureterocele should not deter us from searching for an associated pathology like a ureteric valve when imaging shows more severe hydronephrosis suggestive of more proximal obstruction.

The fate of lower pole hydronephrosis after transurethral incision of upper pole ureteroceles in children with duplex systems

Duplex system is the most common upper urinary tract anomaly in childhood. The purpose of our study was to investigate the incidence, characteristics, and progression of lower pole hydronephrosis in children with duplex system who underwent transurethral incision (TUI) of upper pole ureterocele. Among children who underwent transurethral incision of ureteroceles between 2006 and 2018, 69 renal units with duplex systems were included after exclusion of preoperative lower pole vesicoureteral reflux and follow up loss. We retrospectively analyzed the postoperative progression of lower pole hydronephrosis and compared patient characteristics between two groups according to the presence of lower pole hydronephrosis. The median age at operation and follow-up duration were 3.0 months (range 0-242 months) and 59 months, respectively. The median size of ureteroceles preoperatively was 14.5mm. Thirty-five renal units (50.7%) demonstrated preoperative lower pole hydronephrosis of any grade (grade I in 13 [37.1%], II in 6 [17.1%], III in 10 [28.7%], and IV in 6 [17.1%]). In majority of cases, lower pole hydronephrosis drastically improved after transurethral incision, and 28 renal units (80%) demonstrated improvement of lower pole hydronephrosis to grade 0 or I. The preoperative diameter of upper pole ureter was significantly increased with lower pole hydronephrosis than without (11.30±4.19 vs. 7.02±4.94mm, p<0.01). Postoperative vesicoureteral reflux on upper pole was found in 16 (23%), five (7%) in lower pole. Eleven patients developed complications after TUI which required secondary surgeries. The differential renal function of affected renal units was decreased after TUI in group with preoperative lower pole hydronephrosis (46.77±8.21 to 44.24±8.55, p=0.003), while it was maintained without significant difference in group without lower pole hydronephrosis (47.90±6.39 to 46.24±8.90, p=0.091). Lower pole hydronephrosis was found in a considerable number of renal units (50.7%), and the occurrence was related with the diameter of upper pole ureter. Most of renal units demonstrated significant improvement of lower pole hydronephrosis after transurethral incision of ureterocele. Given that differential renal function may be decreased even after improvement of hydronephrosis with TUI, a more careful monitoring on renal function is required in patients with hydronephrosis on lower pole.

Optimal settings for the Holmium: YAG laser in pediatric endourology: Tips and tricks

To the best of our knowledge, no pediatric paper has been published regarding specifically how to set the Holmium:YAG laser for multiple urologic applications. To provide insight into the laser parameters for pediatric applications. We describe the principle and the settings of the laser. The Holmium:YAG laser can produce four different biological effects: (1) fragmentation of stones in small fragments that can be retrieved with grasping instruments, thereby increasing the immediate stone-free outcome. For fragmentation lithotripsy, the laser has to be set with a high energy, low frequency and short pulse duration; (2) dusting which produces fine dust that can spontaneously evacuate, avoiding the use of basket retrieval. The dusting setting requires low energy, high frequency and long pulse duration; (3) incision of posterior urethral valves or ureterocele when all settings are maximized: high energy, high frequency and long pulse duration; (4) coagulation of urothelial tumors using high frequency, long pulse duration and slightly lower energy than required for incision. Both dusting by painting and fragmentation with retrieval for ureteroscopic laser lithotripsy are effective. Although dusting tends to be associated with shorter operative times and a lower risk of ureteral trauma, this approach has a potential risk of recurrent stone formation from dust failing to pass. In contrast, fragmentation with extraction may provide for a more immediate postoperative stone-free result. Altering the pulse energy, frequency, width and modulation can help to optimize lithotripsy efficiency. Lower pulse energy settings result in smaller fragments, less retropulsion and reduce fiber tip degradation. A shallow depth of penetration in water and tissue allows precise energy application and provides a margin of safety. An understanding of Ho-YAG laser settings will permit the pediatric surgeon to make a better use of the device for different urological applications.

Giant ureterocele management in an adult male: A rare case report

Ureterocele is dilatation of lower ureter at its entry into the urinary bladder. It is classified into the single or duplex system and acquired or congenital. Acquired type is rare and seen in adults. We report the case of a 23-year-old male presented with voiding lower urinary tract symptoms and intermittent flank pain. He had a history of frequent spontaneous stone passage with right colicky pain 2 years back. On ultrasonogram and magnetic resonance urogram, diagnosis was made as right renal hydronephrosis with hydroureter due to right side giant intravesical ureterocele. The patient was managed by endoscopic transurethral incision and excision of ureterocele. It is the first case ever reported in the literature, where in giant ureterocele was completely removed by total endoscopic approach.

Antenatally detected ureterocele: Associated anomalies and postnatal prognosis

ObjectiveWe purposed to review prenatal diagnoses of ureterocele, to determine the sonographic findings and additional abnormalities, and to illustrate the pregnancy outcomes of these patients. Material and methodsWe reviewed the records of 24 patients with the diagnosis of ureterocele in our referral center between January 2010–March 2017. Prenatal sonographic findings, antenatal course, and postnatal follow-up were obtained. ResultsThe mean gestational age at first US diagnosis was 24.5 ± 2.9 weeks. 13 (54.1%) of fetuses were female, and 11 (45.9%) were male. Ureterocele was associated with the duplex kidney in 17 (70.8%), MCDK in 5 (20.8%) and hydronephrosis with a single system in 1 (4.2%) and pelvic kidney in 1 (4.2%) fetuses. Postnatal follow-up was achieved in 22 of 24 (91.6%) cases, and mean follow-up interval was 56 ± 14.2. Months. The diagnosis of ureterocele was confirmed in 22 (91.6%) cases postnatally. 15 of 22 (68%) cases were classified as extravesical ureterocele, and 7 (32%) cases were intravesical ureterocele. Postnatal confirmation of duplex kidney achieved in 16 of 17 (94.1%) patients. 17 (77.2%) patients were required surgical intervention, and 5 (22.8%) cases were managed conservatively. 15 of 16 (93.7%) cases who were diagnosed duplex kidney underwent surgery however 2 of 5 (40%) cases which were confirmed MCDK required an operation. Cystoscopic ureterocele incision was the initial approach for the surgical management and performed all of the cases which required surgery. It was curative in 10 of 17 (58.8%) patients and 7 (41.2%) cases needed to further operations. Ureteroselectomy and common-sheath ureteroneocystostomy was performed in 5 (29.1%) cases and. 2 (%11.7%) cases underwent partial nephrectomy. ConclusionUreterocele can be accurately diagnosed by prenatal sonography, and it is a significant clue for the diagnosis of a duplex kidney. Postnatal prognosis depends on associated anomaly and presence of reflux and upper pole function.

Minimally Invasive Laser Treatment of Ureterocele.

Introduction: Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy.Materials and methods: Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5–0.8 joule energy, through 8–9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18–24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6–18 months in selected cases. Statistical analysis was utilized for data evaluation.Results: From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1–168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6–18 months follow-up for recurrent dilatation. Urinary tract infections and de novo refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls (p < 0.05). Further surgery was required in 12 patients (18%) at 1–5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group (p < 0.05).Conclusions: Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery.

Endoscopic intact removal of medium-size- or multiple bladder stones with the use of transvesical laparoendoscopic single-site surgery

ObjectivesTo determine the feasibility and safety of performing transvesical laparoendoscopic single-site surgery (T-LESS) in patients with medium-size, hard stones or multiple stones with high burden.MethodsIn this case series study, 12 patients (11 males and one female) with a mean age of 66.8 years were operated on from February 2016 to May 2017 due to bladder calculi, using the T-LESS approach with a single-port device (Tri-Port + , Olympus, Germany). Indications for this procedure were hard, medium-size, solitary stones after previous unsuccessful endoscopic lithotripsy or the presence of multiple high-burden stones. In two patients, additional procedures (diverticulectomy or a ureterocele incision) were performed simultaneously.ResultsAll stones were removed intact. No serious complications were observed. The mean operative time was 46 min and the postoperative hospital stay was 22 h. The mean diameter of the largest stone and the mean stone volume of each case were 24 mm and 11 cm3, respectively. At the mean follow-up time of 15 months, there was significant improvement of the symptoms.ConclusionsThe T-LESS technique is an efficient, safe and minimally invasive procedure for intact bladder stone removal in selected patients. The method avoids the risk of urethral injury. Nevertheless, further investigation is needed to assess the wider applicability of the procedure.

Transurethral incision of ureteroceles in paediatric age group.

Ureteroceles are a great clinical challenge because of variations in anatomy and clinical presentations. We present our experience with primary transurethral incision of ureteroceles in children. Data of thirteen children managed for ureterocele from 2009 to 2016 was retrospectively analyzed with respect to age, sex, clinical presentation and symptomatology, type and localization of ureterocele, investigations, surgical management and follow-up. A total of 13 patients with ureteroceles were managed. There were 7 males and 6 females. Six were neonates with antenatal diagnosis of ureteroceles. Five patients presented with urinary tract infection and two were diagnosed during ultrasound for abdominal pain. The ureteroceles were on the right side in 7 patients and left in 6 patients. Six patients had a duplex system-five on right side and bilateral in one. Two patients had ureteroceles in solitary kidney. Four patients had associated hydronephrosis and hydroureter and two had only hydronephrosis alone. One patient had bilateral grade III reflux in the bilateral lower moieties of the patient with bilateral duplex system. Two patients had poorly functioning kidney on radionuclide scan. All patients underwent cystoscopic incision of the ureteroceles. Eleven had intravesical ureteroceles and two had large caeco-ureteroceles. Two patients required ureteric reimplantation during follow-up. Though the approach of managing a patient with ureterocele should be individualized, transurethral incision remains valuable as a primary intervention with regular follow up. It may even prove to be the only intervention required in most of the patients.

Transurethral incision of ureterocele: Does the time of presentation affect the need for further surgical interventions?

Ureterocele management is considered to be one of the famous debates in pediatric urology. Despite some considering transurethral ureterocele incision (TUI) as a temporary line of treatment, others have reported good results in terms of being a definitive treatment. The present study evaluated the feasibility of TUI as a definitive line of management. Moreover, it studied the impact of presentation on the outcomes. The charts of patients who had ureteroceles from 1995 to 2015 were retrospectively reviewed. Patients who had undergone initial TUI were included. The initial presentation and timing were recorded. All ultrasounds, voiding cystourethrograms (VCUG) and dimercaptosuccinic acid scans (DMSA) pre-TUI and post-TUI were reviewed. Moreover, the occurrence of febrile urinary tract infections (FUTI) and any secondary surgical intervention were recorded. RESULTS (FIG. A): A total of 51 patients with 53 ureteroceles were included. Of these, 51% presented antenatally, while others had FUTI at the time of presentation. Thirty-nine ureteroceles were associated with duplex system ureterocele (DSU), while the remaining ones had single system ureterocele (SSU). The median follow-up was 44 months. The incidence of de-novo reflux into ureterocele was 44% of SSU and 23% of DSU (P=0.22). Reflux into ureterocele after TUI (four SSU and seven DSU) carried a high risk of surgical interventions (3/4 SSU and 6/7 DSU). Hydronephrosis was improved in 64% of both DSU and SSU patients. Secondary surgery was performed in 51% of DSU and 35.7% of SSU. Twelve patients (67%) presented postnatally with DSU and had subsequent interventions after incision in comparison with 38% (eight patients) of those who presented antenatally. The DSU had improved renal function (by DMSA) in 26%, while the remaining had stable renal function. All patients with delayed ureterocele presentation had FUTI, while 1/3 of antenatally presenting patients had FUTI during follow-up. Notably, the age at subsequent interventions was apparently the same despite different ages at presentation. Study limitations included the retrospective chart review. Additionally, the pre-operative and postoperative investigations, such as laboratory and radiological results, were present and reviewed in most, but not all, patients. Two thirds of SSU and approximately half DSU patients had no surgical intervention after TUI. However, those who presented antenatally had a lower risk of FUTI and lesser probability of being re-operated. VUR into ureterocele, regardless the system duplicity, had a high re-operation rate. After ureterocele incision, 26% of DSU patients had renal function improvement.

Diagnosis and Treatment of Palpable Urological Mass in the Neonatal Period: A 5 Year Review

Introduction: Abdominal masses in the neonatal period often present a diagnostic challenge. The aim of this study was to evaluate which urological pathologies cause the formation of a neonatal mass, the diagnostic pathway and surgical outcome. Patients and methods: The medical and radiological records of 30 neonates who were admitted to the Neonatal Surgical Unit of Yorkhill Sick Children Hospital, Glasgow with an abdominal mass over a five-year period (2008-2013) were reviewed. Data collected included demographics, gestational age, radiological investigations, operative findings and complications. Result: Seventeen neonates (9 males, 8 females) were identified with an abdominal mass arising from the urological tract. Four boys were found to have posterior urethral valves while in 4 girls a duplex kidney with a ureterocele was identified. In the remaining 9 patients the palpable mass was caused by: vesicoureteric reflux (n=2), multicystic dysplastic kidney (n=2), polycistic kidney disease (n=1), ectopic kidney (n=1), pelvi-ureteric junction obstruction (PUJO) (n=1), unilocular renal cyst (n=1), PUJO and vesicoureteric junction obstruction (n=1). Nine patients required a form of urinary diversion and in two of these patients a nephrostomy was followed by a pyeloplasty, 2 required incision of ureteroceles, 1 nephrectomy, 1 partial nephrectomy, 1 STING and 1 primary valve ablation. Conclusion: Only 70% of newborns with abdominal masses were diagnosed antenatally, while 30% were detected postnatally. Posterior urethral valves remain the most common cause of a neonatal mass in a male, while duplex kidneys with ureterocele were seen in girls. Half of the patients will require a form of urinary diversion in the neonatal period. The large majority (88%) of abdominal masses of urological origin required surgical intervention.

PE87 - Robot assisted laparoscopic ureteroneocystostomy for vesicoureteral reflux after ureterocele incision for huge ureterocele with multiple stones

PE87 - Robot assisted laparoscopic ureteroneocystostomy for vesicoureteral reflux after ureterocele incision for huge ureterocele with multiple stones

Adult unilateral duplex system ureterocele with multiple calculi

Ureterocele is a congenital cystic dilatation of the distal portion of the ureter. A was admitted to our hospital with complaints of pollakuria, right flank pain and macroscopic hematuria. Direct urinary system X-ray suggested a right lower ureteral calculi and intravenous pyelography (IVP) revealed a right side complete duplex system of ureterocele, multiple distal ureteral calculi and characteristic appereance of cobra head or ''spring onion''. A transurethral transversal incision was made in the right ureterocele at the inferior lateral border and 176 spherical calculi of almost the same size were removed. In conclusion, endoscopic ureterocele incision and stone extraction is a safe and effective treatment of adult orthotopic ureteroceles and this technique has minimal risk for iatrogenic vesicoureteral reflux.

Unilateral Ureterocele Presenting With Multiple Stones In An Old Lady: Endoscopic Incision and Stone Extraction

In this video supported case report, we aimed to present our step-by-step technique of endoscopic incision of ureterocele and stone extraction in a 66 years old female &nbsp;patient with a large ureretocele containing multiple urinary stones. The patient was with the complaints of flank pain and disuria. The patient&nbsp; was prepared under spinal anesthesia and positioned in lithotomy position. Under direct visualisation of cystoscopic view, the ureterocele and other ureteral orifice of the duplicated urinary system have been detected. A ureteral catheter was placed into the other ureter for safety. Subsequently, a transverse endoscopic incision was performed by using a 26 F standard resectoscope with an electrical loop of TUIP at the inferior lateral border, and an artificial secondary ureteral orifice has been created. Though this new orifice, the resectoscope was inserted into the ureter, and multiple ureteral stones were seen inside the ureterocele and dilated ureter. These stones were extracted by using stone forceps and directly irrigation and decompression of the ureteral lumen. No stone fragmentation was required in this operation. After the elimination of all of the stones, a 4.8 F DJ stent was inserted into the ureter and the procedure has been completed without any complication. At the postoperative follow up period, no complication was occurred and all of the complaints were improved.

Unilateral Ureterocele Presenting With Multiple Stones In An Old Lady: Endoscopic Incision and Stone Extraction

Abstract In this video supported case report, we aimed to present our step-by-step technique of endoscopic incision of ureterocele and stone extraction in a 66 years old female patient with a large ureretocele containing multiple urinary stones. The patient was with the complaints of flank pain and disuria. The patient was prepared under spinal anesthesia and positioned in lithotomy position. Under direct visualisation of cystoscopic view, the ureterocele and other ureteral orifice of the duplicated urinary system have been detected. A ureteral catheter was placed into the other ureter for safety. Subsequently, a transverse endoscopic incision was performed by using a 26 F standard resectoscope with an electrical loop of TUIP at the inferior lateral border, and an artificial secondary ureteral orifice has been created. Though this new orifice, the resectoscope was inserted into the ureter, and multiple ureteral stones were seen inside the ureterocele and dilated ureter. These stones were extracted by using stone forceps and directly irrigation and decompression of the ureteral lumen. No stone fragmentation was required in this operation. After the elimination of all of the stones, a 4.8 F DJ stent was inserted into the ureter and the procedure has been completed without any complication. At the postoperative follow up period, no complication was occurred and all of the complaints were improved.

Pediatric procedures in urology residency training: An analysis of the experience of Canadian urology residents

We sought to determine if the exposure to pediatric urologic procedures by graduates of Canadian urological programs is congruent with the objectives of training (OTR) put forward by the Royal College of Physicians and Surgeons of Canada (RCPSC). The Canadian T-Res (Resiliance Software Inc., Vancouver, BC) database for pediatric surgical procedures logged from 2003 to 2009 was interrogated. The number of cases logged for each of the A, B and C lists of procedures (least complex to most complex) as outlined in the RCPSC OTR in Urology were recorded for the 6 participating programs across the country. A total of 48 residents submitted data to T-Res from the 6 participating programs. Of the A-list procedures, Canadian urology residents (PGY 1-5) from the 6 participating programs participated in an annual average of 53 hypospadias repairs, 30 orchidopexies for inguinal testes, 26 circumcisions, 7 hernia/hydrocele repairs, 7 pyeloplasties, 7 ureteral reimplants, 6 endoscopic injections for vesicoureteral reflux, 3 meatoplasties/meatotomies, 1 transurethral incision of ureterocele, 2 endoscopic procedures for stone management, and 1 transurethral incision of ureterocele, during the years in question. Of the B-list procedures, residents participated in an annual average of 1 transurethral resection of a posterior urethral valve, 3 continent diversions, 2 augmentation cystoplasties and 1 vesicostomy. Of the data available for the C-list procedures, residents participated in an annual average of less than 1 exstrophy repair and less than 1 pediatric renal transplant. The RCPSC objectives set out by the specialty committee are a useful framework for guiding graduating residents on which procedures they might reasonably perform once they enter practice. Ongoing revisions to these objectives, which reflect changing trends in the management of core pediatric urology procedures, are supported by our study based on the number of cases in which residents participate. Improvements in the assessment of trainee surgical experience and competence, as it relates to the objectives of training in pediatric urology, are required as we migrate towards a competency-based model of postgraduate medical education.