Single System Ureterocele Research Articles

Bilateral Calculi in a Child With Bilateral Single System Ureteroceles

Ureteroceles in children are detected with prenatal sonography and less commonly during the evaluation following a urinary tract infection. Rarely do ureteroceles in the pediatric population present with stones, particularly in a bilateral fashion. We present a case of a 5-year-old boy found to have bilateral intravesical single system ureteroceles harboring multiple large calculi treated successfully with a staged endoscopic approach.

Ureterocele Masquerading as Obstructive Uropathy in a Sexagenarian—a Classical Image

Ureteroceles diagnosed in adults are usually asymptomatic. Ureteroceles can rarely cause obstructive uropathy and urosepsis. We present a 65-year-old gentleman with urinary retention and recurrent urinary infections. He had developed multidrug-resistant urinary tract infection and acute kidney injury. He was detected to have bilateral single-system ureteroceles. We performed ureterocele incisions and his serum creatinine normalized. We report this case for its rarity and diagnostic dilemma and as that ureteroceles in adults may need definitive treatment under certain special circumstances.

Stone cobra: “Adult” left single system ureterocele with 139 calculi-case report and review of the literature

A 35yr old man old with no previous major clinical issues presented with a 2years history of radiating left flank pain and dysuria. Abdominopelvic ultrasonography and an intravenous urography confirmed a bladder stone and a left single unit ureterocele harboring multiple stones showing as a typical “Cobra head” with resultant hydronephrosis.

Multiple stones in a pediatric case of single-system ureterocele with vesicoureteral reflux

Presence of multiple calculi in a single system ureterocele is a rare condition. A 3-year-old boy presented with recurrent urinary tract infections in whom on x-ray and ultrasound multiple calculi were noted in the urinary bladder. In addition, ultrasound showed the presence of ureterocele in the size of 18x15x12 mm. Open surgery revealed an ureterocele with multiple stones. Here, we present a boy with multiple stones in the left ureterocele diagnosed intra-operatively due to its rarity, etiology and treatment options.

Multiple calculi in a single-system orthotopic ureterocele in a two-year-old boy presenting with hematuria: A case report

Ureterocele is the dilatation of the submucosal ureter as a result of a defect in the Chwalla membrane absorption. The many types and clinical presentations of ureters present a significant challenge to clinicians. Although stone formation in the ureterocele is common in adults, it is much less common in pediatric patients. Here, we present a case report of a two-year-old boy with single-system ureteroceles containing multiple small stones.

Active surveillance for antenatally detected ureteroceles: Predictors of success

Historically, ureteroceles were surgically treated, as patients were diagnosed after developing symptoms. However, with the advance of fetal medicine, antenatal detection has provided an opportunity to look at the natural history of ureteroceles. With data derived from a retrospective chart review of patients with ureteroceles that were detected antenatally, the current study aimed to determine which group of children would be at risk for failure on active surveillance. It was hypothesized that single system ureteroceles (SSU) and male patients with duplex system ureteroceles (DSU) would be ideal for observation. Outcomes were assessed by descriptive statistics. Kaplan-Meier curves were utilized to estimate median duration on active surveillance in both single and duplex cohorts. Breakthrough febrile urinary tract infection (fUTI) and surgery were determined by Cox regression in the duplex system cohort. Surgery was considered surveillance failure. A total of 102 patients (64 females/38 males) met the criteria: 78 (76.5%) had DSU and 24 (23.5%) SSU. The overall median observation was 1.2 years (range 0.7-3.1). Follow-up ranged from 0.3 to 11.7 years for SSU, and from 0.02 to 17.3 years for DSU. The predictors of failure of active surveillance (AS) in DSU (surgical intervention) were male gender (HR 1.8, 1.0-3.3, P=0.037), or fUTI (HR 3.1, 1.7-5.8, P=0.002). Predictors of fUTI were contralateral hydroureter or ipsilateral hydronephrosis ± hydroureter (OR 9.5, 1.2-71.7, P=0.028). Interestingly, vesicoureteral reflux (VUR) was not a predictor of fUTI. The SSU patients were ideal for AS, while in DSU, surveillance was successful in 30% of patients who were primarily females without contralateral hydroureter or ipsilateral hydronephrosis±hydroureter. However, in contradiction to the hypothesis, males were at higher risk for surgical intervention in the DSU cohort. Active surveillance is an option for patients with antenatally detected ureteroceles, but careful long term follow up is mandatory. Parents should be advised that surgical intervention may still be necessary, particularly in males with DSU.

Prenatal complicated duplex collecting system and ureterocele-Important risk factors for urinary tract infection.

To evaluate the risk of urinary tract infections (UTIs) in infants with prenatally detected complicated duplex collecting system (CDS) or ureterocele. All patients with prenatally detected CDS (n=34) or single system ureterocele (n=7) who were admitted to our institution between 2003 and 2013 were enrolled in this retrospective analysis. Duplex collecting systems with ureterocele (n=13), vesicoureteral reflux (VUR) (n=20) or nonrefluxing megaureter without ureterocele (n=7) were determined as complicated. Twenty-six (63%) patients were females. The prevalence of UTI was compared to 66 controls. The median follow-up time was 5.5 (1.7-12.2) years. Eighteen (44%) patients and 3 (5%) controls had at least one UTI (p<0.001) at the median age of 0.8 and 0.4years, respectively (p=0.481). Fifty-seven percent of the UTIs were breakthrough infections and 82% of those were non-Escherichia coli infections. UTIs occurred prior to any surgical intervention in 4/13 (31%) patients with ureterocele, in 2/14 (14%) patients with VUR, in 4/7 (57%) patients with both ureterocele and VUR, and in 3/7 (43%) patients with nonrefluxing megaureter without VUR or ureterocele (p-values 0.012, 0.209, 0.001 and 0.010, respectively, compared to controls). Postoperative UTIs were observed in 29% of the girls and in none of the 11 boys (p=0.072). The incidence of UTI after perforation of ureterocele was only 14%. Children with prenatally detected ureterocele or duplex collecting system associated with nonrefluxing megaureter are at high risk of UTI despite prophylactic antibiotics. In case of prenatally detected ureterocele we suggest to consider early endoscopic perforation. III.

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.

Ureterocele as a cause of recurrent loin pain

Ureterocele is a congenital saccular dilatation of the terminal portion of the ureter within the urinary bladder. It is an uncommon cause of urinary tract obstruction in the young patient and one of the more challenging anomalies to the urologists. Ureterocele poses a diagnostic and therapeutic dilemma as it manifests a wide spectrum of perplexing clinical symptoms. We report a case of single system ureterocele in a patient presenting with acute severe transformation of recurrent loin pain.

Outcomes of Endoscopic Incision for the Treatment of Ureterocele in Children at a Single Institution

We assessed outcomes in children with ureterocele after transurethral incision at our institution between 2001 and 2014, focusing on end points of vesicoureteral reflux, improvement of hydronephrosis and need for second surgery. We performed chart reviews of 83 patients, collecting information including age at transurethral incision, gender, renal anatomy, ureterocele location, indication for transurethral incision, and preincision and postincision vesicoureteral reflux and hydronephrosis status. Patients were divided into those with single system and duplex system ureteroceles, and intravesical and extravesical location for analysis. Statistical evaluations were performed with the Wilcoxon rank test and Fisher exact test. Transurethral incision was performed at a mean age of 34.2 months in patients with single system ureterocele and 8.9 months in those with duplex system ureterocele (p <0.0001). Cure rates (improvement of hydronephrosis and absence of vesicoureteral reflux) were 55.6% in patients with single system ureterocele and 14.9% in those with duplex system ureterocele (p = 0.0031). Rates of de novo reflux into the ureterocele moiety were 27.8% for patients with single system ureterocele and 56.2% for those with duplex system ureterocele (p = 0.0773). Patients with single system ureterocele required significantly fewer second surgeries (3.8%) than those with duplex system ureterocele (73.7%, p <0.0001). Patients with single system ureterocele may benefit from endoscopic incision. Transurethral incision was definitive in all such patients except 1 in our study. Although most patients with duplex system ureterocele will need a second operation, transurethral incision remains of value in this population in instances of sepsis or bladder outlet obstruction, or to facilitate planned reconstruction when the child is older.

Prolapse of a Single System Large Ureterocele Containing Multiple Stones in a Pregnant Woman

Periurethral masses are uncommon in adult women, with little guidance on initial management. We describe a case of a 29-year-old pregnant woman with a single-system ureterocele prolapse complicated by multiple calculi ranging from 1 to 2.5 cm.

Prolapse of a single-system ureterocele causing urinary retention in an adult woman

A 41-year-old woman presented with pelvic pain and a bulge from her urethra. On physical examination, she was noted to have a mucosal bulge from her urethra that intermittently squired urine. Further imaging showed single systems on both sides, no stones, and mild left-sided hydroureteronephrosis with a ureterocele. The ureterocele was endoscopically incised and excised, resolving her symptoms.

Ureterocele in adults: Management of patients in Zaria, Nigeria

Background: Ureterocele is a cystic dilatation of the distal ureter. It remains a rare urologic condition in non-Caucasians and is even less common in adults. Single-system ureteroceles are usually found in adults, and thus the name adult ureterocele. Though uncommon, urologists practicing in this region should be acquainted with the management. Materials and Methods: A retrospective review of folders of 10 adult patients who were admitted for surgical treatment of ureterocele in our center between 2000 and 2009 was done. The information obtained included: age, sex, type and number of ureterocele, associated disease, type of surgical intervention, complications, and follow-up. Results: The age range was 20-49 years, with a mean age of 31 years. Of these patients, seven were females and three were males. Six patients had unilateral ureterocele while four had bilateral disease, making a total of 14 ureteroceles. The presenting symptoms were flank pain and painful micturition, each occurring in 60% of the patients. Genitourinary tuberculosis was diagnosed in 4 (40%) patients. Other associated pathologies were impacted stone in the ureterocele and vesical schistosomiasis. The treatment was mainly by open method (70%), while the rest had endoscopic treatment. All the patients did well and there were no significant perioperative complications. Conclusion: The finding of associated pathology in our patients supports the theory of an acquired origin. Urologists practicing in this region need to have a high index of suspicion and be acquainted with the variable clinical presentations, radiographic features, and treatment options in order to be able to effectively manage these occasional cases.

446 CHARACTERIZATION OF SINGLE SYSTEM URETEROCELE IN ASSOCIATION WITH IPSILATERAL MULTICYSTIC DYSPLASIC KIDNEY

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Kidney & Ureter1 Apr 2011446 CHARACTERIZATION OF SINGLE SYSTEM URETEROCELE IN ASSOCIATION WITH IPSILATERAL MULTICYSTIC DYSPLASIC KIDNEY Beth A. Drzewiecki, John C. Thomas, Stacy T. Tanaka, John C. Pope, Mark C. Adams, and John W. Brock Beth A. DrzewieckiBeth A. Drzewiecki Nashville, TN More articles by this author , John C. ThomasJohn C. Thomas Nashville, TN More articles by this author , Stacy T. TanakaStacy T. Tanaka Nashville, TN More articles by this author , John C. PopeJohn C. Pope Nashville, TN More articles by this author , Mark C. AdamsMark C. Adams Nashville, TN More articles by this author , and John W. BrockJohn W. Brock Nashville, TN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.538AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ureteroceles most commonly present in duplicated renal systems and are associated with the obstructed upper pole moiety. We report our experience with single system ureteroceles (SSU) in conjunction with ipsilateral multicystic dysplasic kidney (MCDK). METHODS We retrospectively reviewed the charts of all patients diagnosed with MCDK (ICD9 753.19) and ureterocele (ICD9 753.23) between January 1, 2000 and July 31, 2010 to identify children with SSU and MCDK. We excluded patients with dysplasia associated with posterior urethral valves (4), only one clinic visit (19), surgical pathology not consistent with MCDK (7), other diagnoses (9), and mothers seen for prenatal counseling (33). Gender, laterality, location, contralateral vesicoureteral reflux (VUR) and treatment were evaluated. Results were compared using Fisher exact probability test. RESULTS A total of 210 (54% male and 46% female) were included in the analysis. With the exception of 5 children, all were diagnosed prenatally with a presumed MCDK and confirmed post natally with ultrasound and/or renal scintography. Single system ureteroceles were identified in 21 children (10%), 19 males and 2 females. Male gender was significant for development of SSU (p<0.00). There was no difference in laterality between the two groups. Contralateral VUR was identified in 3 (14%) children with SSU compared to 34 (18%) in those with MCDK alone (p=0.8). Ureteroceles were classified as ectopic (10) and intravesical (11) based on cystoscopy and/or cystography. Treatment consisted of nephrectomy (16), transurethral incision (2) and observation (3). Indications for nephrectomy included large size of MCDK (5), reflux into system (2), ureterocele causing obstruction or significant distortion (6), and parental wishes (4). CONCLUSIONS MCDK may result from an improper union between the ureteric bud and metanephric blastema, however defects of the distal ureteric bud are under reported. Single system ureterocele in association with ipsilateral MCDK is rare, and are more predominant in males. Contralateral vesicoureteral reflux associated with MCDK is independent of ureterocele. Indications for surgery may vary, however observation remains a viable option for some patients. MCDK MCDK and SSU No. of patients 189(90%) 21(10%) Male 95(50%) 18(86%) Female 94(50%) 3(14%) Side Right 90(48%) 9(43%) Left 99(52%) 12(57%) Contralateral anomaly VUR 34(18%) 3(14%) UPJ 4(2.1%) 0(0%) © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e181-e182 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Beth A. Drzewiecki Nashville, TN More articles by this author John C. Thomas Nashville, TN More articles by this author Stacy T. Tanaka Nashville, TN More articles by this author John C. Pope Nashville, TN More articles by this author Mark C. Adams Nashville, TN More articles by this author John W. Brock Nashville, TN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prolapsed single system ureterocele in a female adult: case report

A 36 year old female teacher, presented with a bleeding mass in the introitus, difficult micturition, and dysuria of four months duration. She was a para 3+0, all spontaneous vertex deliveries, her last delivery was in 2001. She was first seen at a private mission hospital in March 2006 where an attempt to excise the mass was made but was abandoned due to bleeding. She was later discharged and re-admitted to a second mission hospital. On examination the mass was firm, round in shape about 2.5 cm in diameter, dark red in colour with a catgut stitch and areas of necrosis. The patient was investigated and a diagnosis of a prolapsing ureterocele was made and a transvesical excision was undertaken. A repeat IVP done six months later revealed no hydronephrosis and urea and electrolyte (U/E) were normal. This case is reported to highlight one of the differential diagnoses that should be considered when evaluating masses at the introitus in a female patient. The presentation, diagnosis, and management protocols are discussed. Thus far no local case reports have been established.

Prolapse of a simple ureterocele presenting as a vulval mass in a woman

A 48-year-old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single-system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.

Watchful Waiting for Prenatally Detected Ureteroceles

Ureteroceles are commonly detected by prenatal ultrasound. Although many require surgical intervention due to obstruction of more than one renal moiety or obstruction of the bladder neck, some may be carefully observed. The objective of this study was to assess the outcome of conservative management in select cases of prenatally detected ureteroceles at a tertiary care pediatric hospital. We retrospectively reviewed the charts of patients with ureteroceles detected on prenatal ultrasound who were treated nonsurgically between 1990 and 2001. A total of 10 cases were detected in the course of the chart review, with 6 involving duplex system and 4 involving single system ureteroceles. Median followup was 5 years (range 1 to 11). Patients were followed with routine ultrasound at 3 to 6-month intervals for the first 2 years, and at 6-month to 2-year intervals thereafter. Voiding cystourethrogram and renal scans or IVPs were performed initially in all patients. Those with vesicoureteral reflux were followed with annual or biennial cystogram until reflux resolution. Antibiotic prophylaxis was routinely prescribed for an average duration of 1.5 years. Initial ultrasound revealed unilateral hydronephrosis in all patients, with complete resolution in 6 during a mean followup of 2 years. Voiding cystourethrogram demonstrated vesicoureteral reflux of grade III or less in 4 patients. Reflux resolved in 2 of these patients during a mean followup of 3 years. No patient required surgical intervention within the time frame of this study. There may be a role for watchful waiting in select cases of prenatally detected ureteroceles. Cases involving obstruction of more than one renal moiety, bladder neck obstruction or high grade vesicoureteral reflux were not selected among the population we followed, and would likely require initial surgical management. Patients without these complicating features may be safely followed on suppressive antibiotics, as based on our experience many of the associated problems may resolve without surgical intervention.

Lower Urinary Tract Reconstruction in Ectopic Ureteroceles

Objectives: The management of ectopic ureteroceles is a challenging entity in pediatric urology. In our study, we aimed to determine the outcome after lower urinary tract reconstruction in ectopic ureteroceles. Materials and Methods: A total of 18 (12 girls, 6 boys) children with ectopic ureteroceles, treated between 1993 and 2003 by complete reconstruction, were enrolled in the study and their records were retrospectively reviewed. Results: Ureterocele was found to be unilateral in 16 and bilateral in 2 children. Four patients had been previously managed by endoscopic interventions and 1 patient underwent partial nephrectomy. Ureterocelectomy was performed on 20 renal units, and of these 20 renal units, 9 underwent heminephroureterectomy, 1 ureterectomy, and 3 (with single system ureteroceles) nephroureterectomy. Seven (35%) renal units with adequate function underwent ureteral reimplantations. After a mean follow-up of 5.4 years (range 4 months to 9.5 years), no patient required a second procedure. Contralateral reflux that developed in 2 children after surgical treatment resolved spontaneously after 1 year of follow-up. Conclusion: In the management of ectopic ureterocele, lower urinary tract reconstruction is an effective treatment alternative. According to the functional status of the renal parenchyma involved, the surgical procedure was limited to the lower urinary tract in 35% of the cases.

Assessment and Management of Fetal Hydronephrosis

After completing this article, the reader should be able to: 1. Differentiate genitourinary abnormalities associated with hydronephrosis detected on fetal ultrasonography. 2. Describe the type of fetal hydronephrosis that requires a complete uroradiologic evaluation. 3. Characterize the complete postnatal uroradiologic evaluation of significant fetal hydronephrosis. 4. Delineate the factor that sets the timetable for postnatal uroradiologic evaluation. 5. Describe the neonates for whom diuretic renography is reserved. Ultrasonographic detection of antenatal anomalies in the fetus has increased steadily since its initial widespread use in the 1970s. During these early years, antenatal ultrasonography detected structural abnormalities in approximately 1% to 3% of all pregnancies. (1) Currently, it is estimated that genitourinary anomalies comprise 20% of all antenatally detected fetal anomalies. (2) In a recent British population-based study, fetal genitourinary anomalies were identified in 2.3% of women undergoing routine obstetric ultrasonography between 18 and 23 weeks of gestation. (3) Hydronephrosis clearly has become the most commonly detected antenatal anomaly on fetal ultrasonography. Detection of antenatal dilation of the urinary tract does not always indicate postnatal urinary tract obstruction or even a significant genitourinary anomaly. (4) Among infants diagnosed as having prenatal hydronephrosis or other genitourinary anomalies, the question often is raised about the need for and extent of the postnatal evaluation to assess the magnitude of this commonly detected antenatal anomaly. The purpose of this review is to provide a framework for assessment and management of antenatally detected hydronephrosis. Fetal hydronephrosis is a nonspecific finding that can be associated with multiple congenital anomalies of the genitourinary tract. A thorough understanding of disorders that can result in hydronephrosis postnatally allows the physician to assess the need for postnatal diagnostic tests and guide treatment recommendations. The congenital anomalies that may result in hydronephrosis can be categorized as disorders of urinary reflux and disorders of urinary obstruction. It can be …

DEVELOPMENT OF SMALL CALCULI IN AN INFANT WITH BILATERAL SINGLE SYSTEM URETEROCELES

puncture, 1 while others offer nonoperative treatment with antibiotic prophylaxis. We report on an infant with bilateral, nonobstructing nonrefluxing ureteroceles treated nonoperatively with subsequent development of small calculi in the left ureterocele. CASE REPORT A 6-week-old male with bilateral grade 2 prenatal hydroureteronephrosis had bilateral single system ureteroceles on postnatal sonography (fig. 1, A). The parents reported no history of illness and the patient was on no medication. Antibiotic prophylaxis, including 10 mg./kg. amoxicillin daily, was initiated. A cyclic voiding cystourethrogram confirmed the diagnosis of bilateral ureteroceles, and revealed an otherwise normal bladder and urethra without reflux. Furosemide renography showed bilateral hydroureteronephrosis with homogeneous distribution of radiopharmaceutical from the cortex of each kidney with differential function of 46% and 54% from the right and left kidney, respectively. There was prompt emptying of the renal pelves after furosemide administration. The half-time washout was 6 minutes for the right and 9 for the left kidney, and percentage washout was 81% and 77%, respectively. The patient was continued on antibiotic prophylaxis without incident and evaluated at, ages 4 and 6 months with renal sonography and urinalysis. All urinalyses were negative, and the sonograms revealed stable hydroureteronephrosis, no renal abnormalities and maintenance of good corticomedullary differentiation. However, renal sonography at age 8 months revealed the interval development of 3 small stones in the left ureterocele (fig. 1, B). The patient subsequently underwent transurethral incision of the ureteroceles and extraction of the left ureteral stones. He tolerated the procedure well and was continued on antibiotic prophylaxis. Repeat sonography 1 month postoperatively showed no hydronephrosis or calculi and redundant incised ureterocele tissue (fig. 2). Chemical analysis of the stones revealed 80% calcium oxalate dihydrate, 10% ammonium magnesium phosphate hexahydrate and 10% calcium oxalate monohydrate. A voiding cystourethrogram at age 14 months revealed vesicoureteral reflux grade III on the left side and no reflux on the right. The patient remains on prophylactic antibiotics and has not had a urinary tract infection postoperatively.