Transurethral excision of prolapsed ureterocele

Introduction

A ureterocele is a cystic dilation of the terminal ureter. The incidence ranges from 1/500 to 1/1,200. Ureteroceles are more commonly diagnosed in women; 10 % are bilateral, and 80 % are associated with the upper pole of a duplicated system. A prolapsed ureterocele is one that extends to or beyond the urethral meatus, and the incidence is unknown. Managing prolapsed ureterocele in adult women is not well described in the literature.

Methods

The aim of this video is to demonstrate the technique of transurethral excision of a prolapsed ureterocele associated with a normal kidney in an adult woman, which eliminates the ureterocele while avoiding the morbidity of open surgical excision.

Results

The patient initially underwent transurethral incision of the ureterocele, after which her obstructive symptoms improved. However, she still complained of a mass protruding from her urethra. The patient subsequently underwent transurethral excision of the ureterocele. On the 18-month follow-up, she was voiding without difficulty and had no residual urethral mass. She is being followed clinically, and upper urinary tract imaging will be performed to rule out hydronephrosis or vesicoureteral reflux, as indicated. Pathology revealed urothelial mucosa.

Conclusion

Transurethral incision of a prolapsed ureterocele can be attempted as first-line treatment due to the low morbidity of the procedure. If the patient still has lower urinary tract symptoms, transurethral excision can successfully treat a large prolapsed ureterocele.     

Prolapsed ureterocele after upper pole heminephrectomy

Prolapse of a ureterocele through the external meatus is uncommon, and a prolapsed ureterocele occurring after upper pole heminephrectomy is extremely rare. We describe such a case, occurring 2 months after surgery. The ureterocele was excised with the upper pole ureteral stump, and the lower pole ureter was reimplanted with a good outcome.     

Strangulated Prolapsed Ureterocele: A Solid Vulval Mass in a Woman

We report a rare case of prolapsed ureterocele in an adult female, which had been identified as a small finger-tip sized orthotopic ureterocele 12 years earlier and recently presented a hard neoplastic mass due to strangulation at the urethra and long-standing inflammation.     

Prenatal diagnosis of a prolapsed ureterocele with magnetic resonance imaging

Ectopic ureterocele with ureteral duplication is the most common type of ureterocele found in children. Early accurate diagnosis is desirable to decrease the risk of urosepsis and renal damage. Prenatal imaging with ultrasonography detects the vast majority of ureteroceles; however, in some cases, the diagnosis may remain in doubt. We report on the use of magnetic resonance imaging to clarify the prenatal diagnosis of a prolapsed ureterocele.     

Endoscopic Management of Prolapsing Intravesical Ureterocele in an Adult Female – A Case Report

The authors present a case of intravesical ureterocele in a female which prolapsed out of the external urethral meatus causing urinary obstruction, and was managed by reduction into the bladder followed by endoincision.     

Management of prolapsed ureterocele: past and present.

A prolapsed ureterocele occurs more frequently in female subjects than in male subjects. At least 64 cases in female patients have been reported and an additional case in a 2-year-old girl is reported herein. Only 3 cases have been reported in male subjects. A method for management of a non-reducible ureterocele in female patients is outlined and discussed briefly.     

Strangulated ureterocele and prolapsed urethral mucosa in a little girl. Diagnostic difficulties

The author reports a case of a 2 year-old girl, with prolapse of the urethra treated since birth, twice by electro-coagulations. The persistence of the symptoms required further urological examinations (Urography, Ultrasonography), which revealed an ureterocele, prolapsed into the urethra with total duplication of the urinary tract. The operation consisted of a nephro-ureterectomy of the upper tract, with resection and suture of the exteriorized part of the ureterocele in the urethra.     

Acute retention of urine due to prolapsed ectopic ureterocele in an adult male.

A case is presented of prolapsed ectopic ureterocele which produced severe urinary retention in a 31-year-old male patient. The usefulness of lumbar transcutaneous puncture is emphasized in a case associated with a non-functioning upper pole of a duplex kidney.     

Prolapsed ureterocele

Although rare, the prolapsed ureterocele constitutes a urologic emergency that can rapidly evolve to severe conditions due to congestion and necrosis, and to obstruction of the urinary tract. A simple external resection resolves the emergency, allowing a postoperative investigation of the whole urinary tract to be performed, in order to adequately prepare urinary reconstruction.     

Upper pole heminephrectomy: is complete ureterectomy necessary?

OBJECTIVE: To determine the re-operation rate on the distal ureter after upper pole heminephrectomy with incomplete ureterectomy. PATIENTS AND METHODS: The case notes from one institution were reviewed retrospectively; 60 upper pole heminephrectomies with incomplete ureterectomy were undertaken in 39 girls and 16 boys (mean age at primary surgery 27 months, range 3--88). RESULTS: Thirty-two children (58%) had an antenatal diagnosis while 12 (22%) presented with a urinary tract infection (UTI) and six (11%) with urinary incontinence. Twenty-nine of the 60 renal units (48%) had an associated ureterocele and in nine (15%) the ureter was ectopic. Ten infants (18%) underwent initial puncture of a ureterocele. Five patients (8%), all females, required lower urinary tract re-operation. The indications for secondary surgery were recurrent UTIs in all and a prolapsed ureterocele in one. All five had ultrasonographic evidence of a dilated ureteric stump. Reflux into the retained stump was detected in one child. CONCLUSIONS: The re-operation rate for a redundant ureteric stump in this series was 8%. The risk of injury to the good ureter may outweigh the benefits of a complete ureterectomy.     

Ectopic ureterocele

An analysis of 43 clinical observations helped to establish three variants of ectopic ureterocele: ectopic ureterocele of the accessory ureter, ectopic ureterocele of the doubled ureter. Ectopic ureterocele always brings about obstruction of the ureter. Ectopic ureterocele of the accessory ureter was treated by making anastomosis between the accessory ureter and the main ureter with a removal of all the accessory ureter and dissection of ureterocele. The operation of heminephrureterectomy or dissection of ureterocele with resection of the paracystic part of the ureter were performed with antireflux utererocystoanastomosis.     

A case of ureterocele with ureteral stone and bladder tumor

A case of ureterocele with ureteral stone and bladder tumor is reported. The patient, a 35-year-old man, presented with the complaint of terminal miction pain. IVP revealed the cobra-head appearances of a left-sided ureterocele, ureteral stone and hydroureter. The stone in the ureterocele and the tumor arising from the ureterocele were confirmed by cystoscopic examination. Transurethral biopsy was carried out and followed cystolithotomy, partial cystectomy, partial ureterectomy and ureteroneocystostomy. Histopathological examination of surgical specimens revealed the same feature of transitional cell carcinoma developed from the ureterocele.     

The modern endoscopic approach to ureterocele

PURPOSE: During the last 20 years the surgical approach to ureterocele has evolved from major open surgery to minimally invasive endoscopic puncture. We believe that the endoscopic approach decreases the need for open surgical procedures. We identified specific factors that predict the need for repeat surgery. MATERIALS AND METHODS: We reviewed the charts of 60 new patients with ureterocele treated with primary endoscopic incision between 1991 and 1995. Followup ranged from 4 to 62 months (mean 20). Mode of presentation, ureterocele location, associated vesicoureteral reflux and association of the ureterocele with a duplex system were evaluated. Ureterocele wall thickness was assessed subjectively via radiographic and cystoscopic methods, and categorized as thin, intermediate and thick. RESULTS: All 9 patients with a single system ureterocele had an intravesical ureterocele. No patient had associated reflux nor did any require a secondary open procedure. In 3 cases new onset ipsilateral reflux into the ureterocele spontaneously resolved. Of the 51 patients with a duplex system and associated ureterocele 19 (37%) required a secondary open procedure. The ureterocele was intravesical and ectopic in 22 (43%) and 29 (57%) cases, respectively. Reflux was associated with the ureterocele in 27 patients (53%), and 12 (44%) required a secondary open procedure. A total of 11 patients underwent ureteral reimplantation of 15 refluxing renal units and only 2 renal units required ureteral tapering. Reflux is no longer present in 14 of the 15 renal units (93%). Patients with a thick walled ureterocele required repeat puncture more frequently than those with a nonthick ureterocele. CONCLUSIONS: With the use of modern endoscopic techniques children with intravesical and single system ureteroceles require secondary open surgery less frequently than those with ectopic and duplex system ureteroceles. The mode of presentation does not predict the need for a repeat open procedure. Thick walled ureteroceles require repeat endoscopic puncture more frequently than thin and intermediate walled ureteroceles.     

The safety and efficacy of endoscopic incision of orthotopic ureterocele in adult

Endoscopic incision is a good management option for orthotopic ureterocele. But most of the literature has shown its efficacy only in children. We have done this retrospective study to evaluate the safety and efficacy of endoscopic incision of orthotopic ureterocele in adults. From March 2004 to January 2008, at our center, 26 adults underwent transurethral, transverse incision of an ureterocele. The perioperative data of these patients were retrospectively analyzed. The literature was reviewed to identify all the reported options for management of this relatively rare condition in adults. Unilateral ureterocele was present in 24 patients and two patients had bilateral ureterocele. One patient had associated upper tract stones. Three patients had associated stones in ureterocele. Transurethral, transverse incision of ureterocele was given in all patients. The mean postoperative hospital stay was 50.5 h. Twenty-three patients were available for follow-up at three, six and 12 months. All patients were symptom free. At three months ultrasound and intravenous urography revealed no residual ureterocele but four patients showed residual hydronephrosis, but with a decrease in the grade indicating decompression. Micturating cystourethrography revealed vesico-ureteral reflux (VUR) in two patients and the reflux persisted in one patient even at 6 months. We conclude that in adults, management with endoscopic incision of orthotopic ureterocele is safe and effective. VUR may occur in a few cases.     

MANAGEMENT OF ECTOPIC URETEROCELE ASSOCIATED WITH RENAL DUPLICATION: A COMPARISON OF PARTIAL NEPHRECTOMY AND ENDOSCOPIC DECOMPRESSION

PURPOSE: We compared the efficacy of primary endoscopic decompression versus partial nephrectomy for treating ectopic duplex ureteroceles. MATERIALS AND METHODS: We retrospectively reviewed the records of patients with renal duplication and upper pole ectopic ureterocele. Patients were classified according to the initial radiological evaluation. The operation performed was arbitrarily chosen by the surgeon. RESULTS: A total of 54 patients had unilateral upper or bilateral upper pole ureterocele with no associated vesicoureteral reflux. Partial nephrectomy was performed in 26 patients, of whom 4 (15%) required additional surgery for new onset ipsilateral lower pole reflux. Endoscopic decompression was performed in 28 patients, of whom 18 (64%) required additional treatment due to reflux into the ipsilateral lower pole ureter and ureterocele in 9, reflux into the ureterocele only in 4, ipsilateral lower pole reflux only in 3 and persistent ureterocele obstruction in 2 (p<0.01). An ectopic ureterocele with vesicoureteral reflux into 1 or more moieties was identified in 111 patients, including 56 of 67 (84%) treated with partial nephrectomy and 37 of 44 (84%) treated with endoscopy who have persistent reflux or required further surgery for reflux resolution. CONCLUSIONS: In patients with an ectopic ureterocele and no vesicoureteral reflux partial nephrectomy should be considered the treatment of choice. However, when the initial cystogram reveals vesicoureteral reflux, partial nephrectomy and endoscopic ureterocele decompression have identical definitive cure rates of only 16%. The majority of the latter patients require continued observation and/or additional surgery for managing persistent reflux.     

Laser incision of ureterocele in the pediatric patient.

PURPOSE: We evaluated the effectiveness of initial laser transurethral incision of ureterocele for relieving obstruction, prevention of infection and need for subsequent surgery. MATERIALS AND METHODS: We reviewed the medical records and imaging studies of 30 children with ureterocele treated between 1995 and 2000. Of 30 children 14 underwent initial transurethral laser incision of the ureterocele. Records and images were evaluated for mode of presentation, ureterocele location, thickness, and decompression, and relief of obstruction. The incidence of urinary tract infection, new onset vesicoureteral reflux, upper segment renal function and need for subsequent surgery after incision was investigated. RESULTS: There were 5 boys and 9 girls in our series. Mean patient age at presentation was 17.5 months. There were 12 patients who had ectopic and 2 orthotopic ureteroceles. Ureterocele was defined as thick if ultrasound measurement was 4 mm. or greater. Thick ureterocele was present in 4 (28%) patients. All patients had ultrasound evidence of decompression of the ureterocele and upper tract with 1 treatment. Urinary infection risk was 0.015 per month of followup after incision. Vesicoureteral reflux was present in 8 of 12 (67%) ectopic systems before incision and 9 of 10 (90%) after. None had resolved reflux during followup. Upper pole renal function was assessed by renal scan and/or renal ultrasound. Upper pole function or increased cortical thickness was documented in 9 of 11 (82%) patients. Endoscopic laser incision was the only treatment required in 4 of 14 (28%) patients, including 2 with orthotopic and 2 ectopic ureteroceles. Of 14 patients 5 (36%) had undergone definitive surgery and 5 were followed. CONCLUSIONS: Endoscopic laser incision of ureterocele allows a precise incision and decompression of the ureterocele with 1 treatment. Laser incision of ureterocele should be considered as the initial treatment in most patients.     

Surgical management of ureteroceles in children: strategy based on the classification of ureteral hiatus and the eversion of ureteroceles

Experience in the surgical management of ureteroceles in children is reported. Six patients with intravesical and 16 with ectopic ureteroceles are included. In the case of intravesical ureterocele of noneverting type. Transurethral distal incision of the ureterocele was performed without reflux. In the case of everting ureterocele, excision with reimplantation of the ureter was performed, thus avoiding reflux inevitably induced by transurethral incision. In the patient with an ectopic ureterocele, a one-stage operation with complete excision of the ureterocele and ureteral stump was attempted. Our choice of operative procedure was decided after the assessment of the following features: cystography and cystoscopy to assess eversion, type of ureteral hiatus (common or separate), whether there was reflux or not to the ipsilateral ureter, and renal function by scintigraphy. Accordingly, hemi-nephroureterectomy or twin ureteroneocystostomy were most commonly performed. When based on these thorough preoperative evaluations, our results were quite favorable.     

Ectopic Ureterocele with a Horseshoe Kidney in an Adult

A rare adult case of a left ectopic ureterocele associated with a duplex horseshoe kidney is reported. To the best of our knowledge, only one pediatric case of horseshoe kidney with an ectopic ureterocele has been reported. The present case was successfully treated by ureteropyelostomy, upper ureterectomy and unroofing of the ureterocele. The patient is currently followed with excretory urograms and renograms.     

Diagnosis and management of incidental ureterocele during the treatment of clinically localized prostate cancer

Two instances of simultaneous diagnosis of prostate cancer and ureterocele were recently identified. In one patient an ectopic ureterocele in a duplex system with an obstructed upper pole was unroofed at the time of radical prostatectomy. Surgical excision of the ureterocele wall provided decompression of the obstructed system. In a second patient, bilateral intravesical ureteroceles associated with normal renal units were left untreated. Complications were not associated with the untreated ureteroceles. On rare occasions a ureterocele may be discovered incidentally during the evaluation of patients with prostate cancer. When radical prostatectomy is planned, treatment of the ureteroceles should be determined by the ureterocele's size, anatomic configuration, and location and by the degree of obstruction of the affected renal unit. Surgical excision of the ureterocele at the time of radical prostatectomy may be the best approach for patients requiring treatment.     

小儿输尿管囊肿(附20例报告)

目的对１９９０～１９９８年间收治的２０例输尿管囊肿患者的诊治资料进行总结。方法２０例均行ＩＶＵ及Ｂ超检查。１８例行上肾段及输尿管切除或囊肿切除加膀胱输尿管再吻合术,行经尿道内窥镜囊肿切开及经膀胱双侧输尿管囊肿去顶术各１例。结果Ｂ超诊断符合率为７５％。Ｂ超结合ＩＶＵ诊断符合率达１００％。１３例行上肾段及输尿管切除术,５例行输尿管囊肿切除、输尿管膀胱再吻合术,１例行经尿道内窥镜囊肿切开术,行经膀胱双侧输尿管囊肿去顶术１例。除１例上肾段及输尿管切除术后仍反复泌尿系感染而再行输尿管残端及囊肿切除外,均一次手术治愈。结论Ｂ超及ＩＶＵ二者结合可明显提高诊断符合率。上肾段及输尿管切除或囊肿切除加输尿管膀胱再吻合术方法简单,效果良好,是基本治疗手段之一。对膀胱内型输尿管囊肿、新生儿输尿管囊肿以及输尿管囊肿合并严重泌尿系感染者,可先行经尿道内窥镜囊肿切开术。