The value of endoscopic treatment for ureteroceles during the neonatal period

Abstract

Purpose: We report a series of 35 neonates presenting with ureterocele diagnosed during the antenatal period or during the first weeks of life. The first line treatment was an endoscopic incision.

Materials and methods: Immediate postnatal evaluations detected 37 ureteroceles (bilateral in 2 cases), including 16 of the intravesical type and 21 that were ectopic. Endoscopic incision permitted decompression of the majority of ureteroceles and improvement in renal function in most cases. Secondary low grade vesicoureteral reflux appeared in 9 neonates (ectopic in 8 cases) and had already been present in 14 patients.

Results: Endoscopic treatment alone proved effective in 14 of the intravesical ureteroceles, while the other 2 cases requiring upper pole nephrectomy (1) and ureterovesical reimplantation using the Cohen technique (1). In contrast, among patients with the ectopic form additional surgery was necessary in 18 cases. Treatment comprised resection of the ureterocele with bladder reconstruction and ureteral reimplantation without remodeling according to the Cohen technique in 15 cases, total ureteronephrectomy in 1 and pole nephrectomy in 2.

Conclusions: We suggest that early endoscopic incision be used for first line treatment of ureteroceles. The aim of this procedure is to ensure better urine drainage, preserve function of the parenchyma and reduce the risk of severe infection in the neonate. The principal complication remains secondary vesicoureteral reflux onset, which can be controlled well by antibiotic prophylaxis but requires regular radiological monitoring.