Ureteroceles in infancy and childhood: in search of the correct surgical approach

Between 1967 and 1986, 61 patients with 63 ureteroceles were treated; 53 ureteroceles were associated with duplex, 10 with single collecting systems. Antenatal and postnatal presentation and the means and limits of the possible investigations (intravenous urography, ultrasound, cystoscopy, micturition cystogram, isotope renography) are discussed. Thirty-nine ureteroceles were enucleated either with or without ureteric reimplantation. In patients with duplex systems this procedure was followed by heminephroureterectomy. The operative technique of the enucleation is discussed and the pros and cons of urinary diversion are mentioned. Eight ureteroceles were treated by primary heminephroureterectomy only, however in 75% secondary enucleation or ureteric reimplantation to stop reflux and infection became necessary; 12.5% developed a diverticulum. The remaining 16 ureteroceles were mainly treated unroofing or incision. The overall long-term results regarding reflux, urinary-tract infectios, and continence were excellent; in the majority of cases this was only after full reconstruction of the lower urinary tract. The function of the renal units involved remained constant or improved in 82% of the cases. We are aware that the enucleation procedure is a technically very demanding and time-consuming operation, nevertheless we highly recommend it, as it follows the principle and philosophy of surgical correction, achieving results as near normality as possible.