What should be the approach in a 6 year old female (Presentation UTI) with left Duplex kidneys and double ureter with HDUN and dilated ureter of upper moiety till lower end ending in an Ureterocele? The Ureterocele is the sphincetric type with the mouth stenotic and opening just at the bladder neck. No reflux into either of the 3 ureteric openings. No back pressure changes in the bladder. DMSA shows L VS R 49/51% and Upper vs Lower moiety 33/67%.
Just do multiple tiny hole in the ureterocele without incision to avoid reflux and follow up after 3 months
Smiling face incision. You ay not avoid reflux but relief of obstruction is necessary
Agree with Mallikarjun. Often incision alone suffice. But in this case you have to look at the function of the upper moiety on a DTPA scan.
I agree with Tamer, doing multiple tiny hole on the ureterocele is better doing a big hole and follow up regularly postop.
One hole is enough if you were sure it is a hole ( passing fiber or electrode or seeing flux of urine and collapsing ureterocele)
An endoscopic puncture of the ureterocele will have an 80% chance of solving the problem. Puncture, not incision. If it is a truly intravesical ureterocele this will work.
Long term outcomes based on the initial surgical approach for ureteroceles. Shekarriz B, Upadhyay J, Fleming P, González R, Barthold JS. J Urol.1999; 162:1072-1076.
use the bugby and make a small puncture hole in lower end of the ureterocele. this suppose to be sufficient to decompress it
I agree that cystoscopic puncture with a Bugbee electrode will do the trick with least chance of reflux.
I'll go with cystoscopic incision, and follow up after 1 month
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