129 / 492
S8-11
(P)
FROM OPERATIONS TO OBSERVATION; THE CHANGING MANAGEMENT OF
URETEROCELES.
Michael LEVIN
1
, David WEATHERLY
1
, Theodore BARBER
2
, Jeff PUGACH
3
and George STEINHARDT
2
1) Wayne State University, Department of Urology, Detroit, USA - 2) Helen DeVos Children's Hospital, Pediatric Urology,
Grand Rapids, USA - 3) Cook Children's Hospital, Pediatric Urology, Southlake, USA
PURPOSE
We retrospectively review a 20 year experience of ureterocele 93 patients to compare management in the first 10
years to the most recent 10 year interval.
MATERIAL AND METHODS
All patients with a diagnosis of ureterocele were included. The clinical characteristics for a total of 35 evaluable patients
in the first decade were compared to 58 evaluable patients in the most recent decade.
RESULTS
In the first decade 29/35 (83%) patients underwent surgery, with 12 (41%) undergoing transurethral incision (TUI) and
17 (59%) open surgery. Average age of TUI was 27 months and for open surgery was 42 months. 2 of the 11 TUI
patients underwent further operations. In the more recent decade 48/58 patients presented prenatally. Only 27/58
(46%) patients had any surgical treatment, with 18(66%) undergoing initial TUI and only 9 (33%) initial open surgery.
31/58 (53%) had no surgery at all. Compared to the initial decade this is a statistically significant decrease in surgical
intervention (p=0.0125). In the latter decade 6 patients treated initially with TUI required further surgery, 3 with
repeat TUI and 3 with open surgery. With time, initial open surgery was elected less often and TUI preferred for
simplicity and effectiveness.
CONCLUSIONS
Our experience demonstrates that observation of appropriate patients is a reasonable treatment plan with half of the
recent cohort not requiring any surgical intervention. Initially large ureterocele size, significant lower pole reflux, and
persistent hydronephrosis were relative indications for surgery but with time these factors were less emphasized.