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Summary Introduction Endoscopic laser-puncture or electrosurgical incision are the most commonly used minimaly invasive approaches for the treatment of the ureterocele. Both techniques are mainly successful in decompressing of ureteroceles, but the consequence of such treatment may be formation of de novo vesicoureteral reflux and febrile urinary tract infection which could impact the final results. Objective To compare outcomes of treatment of two endoscopic techniques used in management of neonatal patients with intravesical ureterocele. Study design A case records of 64 neonates who underwent endoscopic procedures for intravesical ureterocele, performed at our institution from January 2005 to January 2021, were retrospectively reviewed. The patients were divided in two groups depending on used endoscopic procedure. The first group (n = 41) consisted of patients who underwent electrosurgical incision of the ureterocele, while the second group (n = 23) consisted of patients in whom 6 to 8 laser-punctures of the ureterocele were performed. The groups were compared in regards to outcomes of treatment, with special emphasis on de novo vesicoureteral reflux and the need for further treatment and surgery. Results Median follow-up was 7.5 (IQR 3, 11.5) and 3.5 (IQR 1.5, 5) years in the electroincision and laser-puncture groups, respectively (P = 0.017). No significant differences between the groups in regards to medians of duration of surgery (12 min vs. 11 min, P = 0.670), length of hospital stay (2 days in both groups, P = 0.988) or postoperative obstruction (n = 1 vs. n = 0, P > 0.999) were recorded. Ureterocele decompression was achieved after endoscopic treatment in 87.9% and 100% of the patients in electrosurgery and laser-puncture groups, respectively (P = 0.150). Five patients (12.1%) from electrosurgery group required endoscopic retreatment. The laser-puncture group had a significantly decreased rate of de novo vesicoureteral reflux (8.7% vs. 58.5%; P = 0.0001) and lower incidence of subsequent surgery due to de novo vesicoureteral reflux (50% vs. 62.5%; P = 0.727). Conclusion Both electrosurgical incision and laser-puncture endoscopic techniques are safe and effective in relieving the obstruction. Laser-puncture technique is associated with significantly lower incidence of de novo vesicoureteral reflux and accordingly fewer invasive procedures for neonatal patients. Summary Table 1 . Treatment outcomes between the investigated groups. Group I Group II P Electroincision (n=41) Laser-puncture (n=23) Complications, n (%) 3 (7.2) 0 0.547 a Intraoperative 1 (2.4) 0 Postoperative 2 (4.8) 0 Endoscopic retreatment, n (%) 5 (12.1) 0 0.150 a De novo VUR, n (%) 24 (58.5 2 (8.7) Grade I 0 0 0.0001 a Grade II 0 1 Grade III 31 1 Grade IV 15 0 Grade V 6 0 a Fisher exact test.

Background: Ureteroceles containing stones present as a unique challenge to the urologist. When a calculus has to be removed from within the ureterocele, a large opening leads to de novo vesicoureteral reflux (VUR), which may result in recurrent infections and renal parenchymal damage. Case Presentation: We present a case of a 13-mm stone in the ureterocele in an 11-year-old boy. He was asymptomatic but presented with abnormal urinalysis results and unilateral hydronephrosis. To avoid de novo VUR, we performed minimally invasive transvesical laparoscopic ureterolithotomy, which included partially suturing the incision at the roof of the ureterocele so that a small opening is maintained for drainage of urine. The surgery was performed with no complications and with normal postoperative urinalysis results. The patient's hydronephrosis resolved, and postoperative voiding cystourethrography showed no VUR. Conclusion: Transvesical laparoscopic ureterolithotomy with partial suturing of the incision at the roof of the ureterocele is a good treatment option, particularly for asymptomatic patients.

Ureteroceles in children are detected with prenatal sonography and less commonly during the evaluation following a urinary tract infection. Rarely do ureteroceles in the pediatric population present with stones, particularly in a bilateral fashion. We present a case of a 5-year-old boy found to have bilateral intravesical single system ureteroceles harboring multiple large calculi treated successfully with a staged endoscopic approach.

Patient: Female, 29-year-old Final Diagnosis: Left duplicated kidney with upper moiety severe hydronephrosis Symptoms: Left side abdominal pain Medication: — Clinical Procedure: Robot-assisted left heminephrectom Specialty: Surgery • Urology Objective: Congenital defects/diseases Background: Duplex kidney, also known as duplex renal collecting system, consists of 2 ureters arising from a single kidney and is a common congenital anomaly. The condition is usually an asymptomatic normal variant. However, abnormal anatomic variants such as hydronephrosis, vesicoureteral reflux (VUR), and ureterocele are sometimes observed in a patient with a duplicated kidney. These abnormal variants usually lead to diagnostic challenges. Here, we report a case of congenital left duplex kidney with hydronephrosis that presented as an isolated left renal cyst in a 29-year-old woman. Case Report: We present the case of a 29-year-old woman who had left-side abdominal pain and fever for 1 day. Left-side flank throbbing pain was also noted. Laboratory investigations showed leukocytosis, pyuria and bacteriuria. Renal ultrasound revealed a huge hypoechoic mass around the left kidney, which was suspected to be a huge renal cyst or renal abscess. Under the impression of acute pyelonephritis with abscess formation, the patient was admitted for antibiotic treatment. The following abdominal computed tomography (CT) revealed a left duplex kidney with severe hydronephrosis and hydroureter. A percutaneous nephrostomy was then performed. Next, following a discussion with the patient, she underwent a robot-assisted left heminephrectomy. Conclusions: A duplex kidney and collecting system should be considered when chronic urologic problems occur. This report shows that because duplex kidney is a relatively common congenital abnormality, it should be considered in the differential diagnosis in young patients who present with renal cyst. This case also shows that patients can be managed effectively using robot-assisted heminephrectomy.

Ureterocele adalah kelainan kongenital pada ureter terminal. Ureterocele berupa massa kistik yang berdilatasi pada segmen ureter intravesikal dapat berkaitan baik dengan ureter tunggal maupun dupleks. Kelainan kongenital berupa obstruksi pada meatus dan timbulnya ureterocele merupakan efek hiperplasia akibat obstruksi ini. Ureter dupleks dapat terjadi pada 75% pasien ureterocele , sementara single ureter hanya 20%. Insidensi ureterocele sebesar 1:4.000 anak dan 4–7 kali lebih sering pada perempuan. Kami melaporkan kasus seorang bayi perempuan berusia lima bulan yang dibawa ke Rumah Sakit Hasan Sadikin tanggal 27 Maret 2019 dengan keluhan utama massa yang tampak menonjol dan hilang timbul pada lubang tempat keluar urine disertai nyeri dan mengedan saat buang air kecil dan demam dalam waktu satu bulan terakhir. Pasien merupakan anak pertama, lahir dari ibu P1A0 riwayat kehamilan cukup bulan. Pada pemeriksaan fisis genitalia eksterna, tampak benjolan berwarna putih dan lunak yang hilang timbul di daerah meatus uretra eksterna. Hasil pemeriksaan BNO-IVP, USG dan CT urologi tampak duplikasi sistem pelvokalises ginjal bilateral dan gambaran berbentuk kantung di daerah vesika urinaria menyokong ureterocele . Berdasar atas hasil anamnesis, pemeriksaan fisis dan pemeriksaan penunjang, pasien didiagnosis ureterocele dekstra, double collecting system bilateral , infeksi saluran kemih komplikata, dan bakteremia. Penatalaksanaan berupa pembedahan eksisi ureterocele dekstra dan reimplantasi ureter. Pencitraan radiologi memiliki peranan penting dalam menegakkan diagnosis ureterocele secara dini untuk menghindari komplikasi dan morbiditas, serta menentukan penatalaksanaan yang tepat. URETEROCELE WITH BILATERAL DOUBLE COLLECTING SYSTEM: A CASE REPORT Ureterocele is a congenital abnormality in the terminal ureter. Ureterocele is dilated cystic mass in the intravesical ureteral segment may be associated with a single or duplex system. Duplex ureters occur in 75% of ureterocele patients, while single ureters are only 20%. The incidence of ureterocele is 1: 4,000 children and 4–7 times more common in girls than boys. We are reporting a five month female infant with an intermittent protruding mass from urethra, accompanied by dysuria and fever in the past one month. The baby was the first child, born by P1A0 mother with a history of term pregnancy. External genitalia examination showed protuding soft white lump in the external urethral meatus. The results of BNO-IVP, ultrasound and CT urology revealed duplications of the bilateral renal pelvocalises system and the appearance of sacs inside bladder sugesting an ureterocele. Based on history, physical and medical examination, the patient was diagnosed as right ureterocele, bilateral double collecting system, complicated urinary tract infection and bacteremia, the management was surgical excision of the right uroterocele and ureter reimplantation. Radiological imaging has a important role in obtaining an early diagnosis of ureterocele, to avoid complications and morbidity and determine an appropriate management.

El ureterocele es una dilatación quística del extremo intravesical del uréter. Una de las teorías más aceptadas para su formación...El ureterocele es una dilatación quística del extremo intravesical del uréter. Una de las teorías más aceptadas para su formación...

Ureterocele is defined as a cystic dilatation of the terminal ureter. It is associated with obstructive uropathy, recurrent urinary tract infections, and acute/chronic renal injury. We present a case of a single system giant ureterocele at the bladder neck in an 8-month-old female infant that presented with an abdominal mass, pus discharge per urethra and failure to thrive. The aim is to highlight an unusual presentation of a giant ectopic left ureterocele in a female infant.

A 24-year-old man presented with urinary frequency, urgency and post-void dribbling of 4 weeks duration. Patient had no history of haematuria, urinary retention, dysuria, graveluria, fever or flank pain. His past medical history and family history were insignificant. General physical examination and

Widespread prenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract. Antenatal hydronephrosis (AHN) and vesicoureteral reflux (VUR) are among the most common congenital anomalies diagnosed in utero or after birth. Pediatric urologists frequently rely on continuous antibiotic prophylaxis (CAP) for managing AHN, VUR, and ureterocele, unless definitive treatment is performed. The main aim of antibiotic prophylaxis (ABP) is to prevent urinary tract infection and long-term complications. Nevertheless, the efficacy of ABP has been a source of considerable debate, and pediatricians have varied opinions on who would benefit from ABP. In this review article, we searched the currently available literature, for evidence of the role of ABP in the setting of AHN, VUR, and ureterocele. Most of our studies showed a limited benefit of ABP for HN and VUR. The data on the use of CAP in the management of ureterocele is scarce. However, due to the involvement of independent risk factors and other variables, a conclusion cannot be drawn from these studies alone. Pediatric urologists are urged to conduct randomized controlled trials to compare patients followed up with and without ABP. Given the lack of guidelines, an individualized approach should be used for the use of ABP, until precise guidelines and recommendations are developed.

Background Uroterocele causes atony and stagnation in the ureter, thus predisposing the patient to stone formation. Multiple calculi in uroteroceles are common in adults but very rare in children. Case presentation We describe the case of a 3-year-old boy who presented with hematuria and was found to have multiple ureteral and ureterocele stones. The diagnosis was made during endoscopic lithotripsy. A holmium/yttrium–aluminum–garnet (Ho–YAG) laser was used to excise the uroterocele and for lithotripsy. Conclusions In appropriate cases, minimally invasive techniques, for example, Ho–YAG laser lithotripsy and ureterocele excision may be preferred.

We present a case of 26-year female who presented with acute urinary retention and vulvar mass. She denies any urinary complaints in the past except for occasional straining for voiding. Imaging revealed a prolapsed ureterocele, it was successfully managed with incision and excising a flap of ureterocele due to the risk of postoperative protrusion of the redundant ureterocele. On follow-up at 6 months she was voiding well without any complaints.

'-Celes' is an ancient Greek language suffix that means 'tumor,' 'hernia,' 'swelling,' or 'cavity.' There are many '-celes' in the abdomen and pelvis that may be encountered during routine imaging interpretation, including santorinicele, choledochocele, ureterocele, lymphocele, mucocele, rectocele, cystocele, peritoneocele, varicocele, spermatocele, hydrocele, hematocele, pyocele and syringocele. Most '-celes' are detected incidentally at imaging for other clinical indications, but some deserve more attention due to a range of clinical symptoms or functional disorder that can adversely affect patient quality of life. The objective of this article was to address all of the '-celes' that a general radiologist and abdominal radiologist should know and be able to recognize. Imaging characteristics, diagnostic clues, and pitfalls have been provided to improve diagnostic accuracy and patient outcomes.

Duplication of the ureters with distal, supra-sphincteric, prostatic implantation is an uncommon congenital anomaly. We report a case of a 35 year-old men presenting with pelvic pain with lower urinary tract symptoms for at least 3 months duration. On magnetic resonance urograms double collecting system in the left kidney and also hydro-uretero-nephrosis in the collecting system which drained the upper pole of the left kidney were seen. The ureter draining the upper pole of the left kidney was seen to open into the prostatic utricle with an ureterocele and multiple stones. Left ureteroneocystostomy was performed. Keywords: Duplicated collecting system, Ectopic ureter, Ectopic prostatic implantation, Ureterocele

Treatment strategies for children with ectopic ureteroceles (EUs) and duplex collecting systems or vesicoureteral reflux are controversial. Transurethral incision (TUI) of EUs associated with duplex systems has been considered only as a temporizing technique. This study aimed to evaluate whether primary TUIs could be considered as an initial treatment option in EUs with duplex systems. Forty-seven children with EUs associated with duplex systems underwent primary TUIs at our institution between November 2007 and October 2017. We retrospectively analyzed patient characteristics such as age, sex, upper tract status, ureterocele location, differential renal function, and preoperative vesicoureteral reflux with regard to postoperative complications requiring additional surgery, postoperative incontinence, and renal function. The mean age at operation was 4.8 ± 4.7 months. Of the 47 patients, 26 (55.3%) underwent primary TUIs only, 3 (6.4%) underwent secondary TUIs, and 18 (38.3%) underwent other secondary procedures such as common-sheath reimplantation (CSR) and ureterocelectomy. Secondary surgeries in 21/47 (44.7%) patients occurred during a mean follow-up of 47.7 ± 23.3 months, and the most common type of secondary surgery was CSR. The most common reason for secondary surgery was febrile urinary tract infection (14/21 patients [66.7%]). There were three cases (3/26 [11.5%]) of voiding problems after primary TUI and two cases (2/15 [13.4%]) after secondary CSR. Primary TUIs should be considered as initial treatment options for EUs in duplex systems and not just a temporizing technique.

Objective To evaluate the management and clinical outcomes of nonfunctioning upper pole moieties treated with either upper pole heminephrectomy or upper pole preservation with lower ureteral reconstruction at a single tertiary institution. Methods After Institutional Review Board (IRB) approval, patients with duplicated systems undergoing upper pole heminephrectomy, ureteroureterostomy, or common sheath ureteral reimplantation from 2012-2017 were identified. Only patients with a nonfunctioning upper pole moiety on ultrasound or renal scan were included. Patients undergoing upper pole heminephrectomy were compared to those undergoing upper pole preservation with respect to demographics, anatomic variations preoperatively, and postoperative outcomes. Results Twenty-seven (57%) patients underwent upper pole preservation with lower ureteral reconstruction; 20 (43%) patients underwent upper pole heminephrectomy. Patients undergoing lower ureteral reconstruction were older (1.63 vs 2.76 years, P = .018) and more commonly presented with lower pole vesicoureteral reflux (67% vs 25%, P = .008). No significant difference in postoperative complications was seen between the two groups. After ureteroureterostomy, one patient developed new onset symptomatic reflux to the upper pole requiring intravesical reimplantation. In the heminephrectomy group, 4 of 11 patients with ureteroceles had ureterocelectomy with concomitant lower pole reimplantation. After heminephrectomy, two additional patients required further interventions: ureterocele excision and transurethral polyp excision. Conclusion For patients with nonfunctional upper poles, lower tract reconstruction is a safe alternative to upper pole heminephrectomy. No significant difference in outcomes was seen. Considering that nearly 1 of 3 of patients with upper pole heminephrectomy required additional lower urinary tract procedures, pursuing upper pole preservation with lower urinary tract reconstruction may be favorable.

This study presents initial experience in endoscopic meatal dilatation of obstructive ureterocele in adult patients. During cystourethroscopy, we tried to find the orifice of ureterocele, passed a guide wire and introduce an 8 Fr ureteroscope in to the ureterocele orifice, going up to the renal pelvis as under vision dilatation of ureterocele meatus. Two Double-J stent were inserted and remained for six weeks to keep the meatus dilated. Adverse effect of endoscopic management was decreased due to minimal anatomic changes. Patients' symptoms were relieved and no evidence of new onset vesico-ureteral reflux and obstruction were seen after up to one-year follow-up. Endoscopic meatal dilatation of stenotic ureterocele in adult patients is safe and effective thus, trying to find the orifice of ureterocele is suggested.

Introduction Large ureteral stone burden can present significant challenges for the urologist to treat. Here we present the retrograde use of the Lithoclast Select TM, in a dilated distal ureter after incision of a ureterocele. Methods The patient is a 64 year-old female with large distal ureteral stone burden, with approximately 15 1-2cm stones . She presented with significant right flank pain, urinary urgency, frequency, dysuria, and recurrent urinary tract infections. Results A 22-French rigid cystoscope was inserted into the bladder. Urethral outlet was normal. Patient was noted to have 2 right-sided ureteral orifices, consistent with a completely duplex system. At the medial right ureteral orifice a very large ureterocele was noted. The lower pole system was scoped and stone free. The ureter to the upper pole moiety was scoped and a large stone burden within the distal ureter was visualized. The Plasmacise Gyrus TM was used to incise the anterior part of the ureter by inserting the Plasmacise into the ureteral orifice and tenting it anteriorly. The 24-French nephroscope was then inserted into the distal ureter. Graspers were used to extract many fragments however several were unable to be extracted from the distal ureter due to their size and thus were fragmented and evacuated with the ultrasonic lithoclast within the distal ureter. A 365-micron laser fiber was also used to fragment some of the stones. There were no complications. CT Scan 4 months post operatively was negative for stone recurrence. Last follow up was 15 months post procedure where the patient was doing well. Conclusions Utilization of the rigid nephroscope and ultrasonic lithotripter in a female patient with a dilated distal ureter with a capacious or incised ureterocele is safe and effective, allowing for treatment of greater than 15cm total distal ureteral stone burden.

OBJECTIVES: To perform a systematic review of studies reporting the outcome of fetuses with a prenatal diagnosis of isolated duplex collecting system (DCS). METHODS: Inclusion criteria were studies reporting the outcome of fetuses with a prenatal diagnosis of isolated DCS, defined as DCS not associated with other major structural anomalies at the time of diagnosis. The outcomes observed were: imaging features of DCS on prenatal ultrasound, associated anomalies detected exclusively at prenatal follow-up ultrasound and at birth, abnormal karyotype, symptoms at birth [including vesicoureteral reflux (VUR), urinary tract infections (UTI)], need for and type of surgical approach, complications after surgery and accuracy of prenatal ultrasound in correctly identifying this anomaly. RESULTS: Eleven studies (284 fetuses with a prenatal diagnosis of DCS) were included. On ultrasound, DCS was associated with ureterocele in 70.7% and with megaureter in 36.6% of cases. Worsening of pelvic/ureteric dilatation was reported to occur in 41.3% of fetuses. At birth, 4.3% of fetuses affected by DCS showed associated renal anomalies. After birth, VUR and UTI presented in 51.3% and 21.7% of children respectively, while 33.6% required surgery. Prenatal diagnosis of DCS was confirmed in 90.9% of included cases. CONCLUSION: DCS diagnosed prenatally is associated with a generally good outcome. Prenatal ultrasound has a good diagnostic accuracy, while detailed post-natal assessment is required in order to identify associated renal anomalies. This article is protected by copyright. All rights reserved.

Extra-adrenal pheochromocytoma is called paraganglioma. Paraganglioma near the ureterovesical junction can be confused with urothelial carcinoma in a ureterocele. Urinary metanephrine can be an indicator for bladder paraganglioma. Metaiodobenzylguanidine scintigraphy is an excellent method not only for distinguishing bladder paraganglioma from other submucosal mesenchymal tumors but also for detecting multifocal lesions. In the present case, we did not perform a preoperative metaiodobenzylguanidine scan because the patient was asymptomatic and urinary metanephrine was negative. Partial cystectomy with ureteroneocystostomy was performed for curative treatment because the tumor was very close to the ureteral orifice.

The management of UCs remain controversial, especially for UCs with duplex collecting systems that still represent a great challenge in paediatric urology. Several approaches have been used and a shared management is not yet validated.Aim of our study is to evaluate the results of the endoscopic treatment of UC comparing ortothopic single-system UC and ectopic duplex-system UC over a 10-year period in a single referral tertiary center. Success was defined as resolution of dilation, lack of urinary infections and preservation of renal function.We retrospectively reviewed medical records of children with a diagnosis of UC who underwent endoscopic puncture at our division from January 2009 to January 2019. Patients were divided in two groups: Group A composed of patients with ectopic UC associated with renal duplex system and Group B with orthotopic UC in single collecting system.We identified 48 paediatric patients treated with transurethral primary endoscopic incision. Groups result homogeneous for clinical and pathological characteristics. The only statistical significative difference between the two samples was the age at diagnosis (p value with Yates correction = 0.01).We considered as a therapeutic success infections control and the elimination of obstruction with preservation of global kidney function. Based on that, our success rate after single (77%) or double (92%) endoscopic treatment is higher than data reported in literature. Differently from previous studies, vescico-ureteral reflux without UTIs was not considered as a failure of the procedure. The present study has some limitations: it is a retrospective and monocentric serie and it lacked a longer follow-up; on the other hand, it has been conducted on a quite large sample size and it is one of the few studies that compares the endoscopic treatment between orthotopic and ectopic UC.Our data report primary endoscopic puncture of ureterocele as a simple, effective, and safe procedure also in long-term follow up. This technique avoids the need for additional surgery in the majority of the patients, also in the case of an ectopic UC associated to a duplex system.

Objective: Ureterocele in a duplex system is rare and commonly presented with urinary tract infection at neonatal age, infant or childhood. Symptomatic ureterocele in reproductive-age is a diagnostic challenge and should be highly awarded to avoid miss-diagnosis. Case report: An adolescent girl with right ectopic ureterocele presented as acute abdomen that mimicked ovarian torsion received emergent laparoscopic surgery. Right ureterocele was identified and excised. Computed tomography later showed bilateral renal duplications with visible renal parenchyma and upper ureters. Recurrent abdominal pain with pelvic abscess occurred 10 days after surgery. Laparoscopic right partial nephrectomy of the upper moiety and resection of the residual ureterocele was performed. Cystoscopy showed absence of intravesical ureterocele and her symptoms were completely resolved after surgery. Conclusion: Infected ureterocele in a duplex system is a rare condition and should be kept in mind as differential diagnosis. Keywords: Acute abdomen, Ureterocele, Duplex system

Robot-assisted laparoscopic surgery (RALS) has been increasingly embraced in the fields of adult and pediatric urology, especially in North America and Europe. The advantages of a stable magnified 3-D view, tremor filtering, and motion scaling allow for precise intracorporeal exposure and suturing. Because most surgeries are performed as reconstructive rather than excision procedures, the robotic platform is particularly feasible for the field of pediatric urology. In this review, we summarize the recent viewpoints on RALS, such as pyeloplasty, ureteral reimplantation, bladder neck reconstruction, bladder neck sling, appendicovesicostomy, bladder diverticulectomy, and treatments for ureterocele or ectopic ureters, and we also critically summarize the current status of the literature. Based on our initial experience, RALS is technically feasible for pediatric patients and may be achieved with comparable surgical outcomes. RALS is also associated with reduced morbidity compared to open surgery to conventional laparoscopic surgery. This evolution will offer an alternative in the treatment pediatric patients, along with improved care and patient quality of life. Further large case series and randomized controlled trials that investigate the robotic platform's technological improvements will help to expand indications of RALS in the field of pediatric urology.

Objectives To determine the feasibility and safety of performing transvesical laparoendoscopic single-site surgery (T-LESS) in patients with medium-size, hard stones or multiple stones with high burden. Methods In this case series study, 12 patients (11 males and one female) with a mean age of 66.8 years were operated on from February 2016 to May 2017 due to bladder calculi, using the T-LESS approach with a single-port device (Tri-Port + , Olympus, Germany). Indications for this procedure were hard, medium-size, solitary stones after previous unsuccessful endoscopic lithotripsy or the presence of multiple high-burden stones. In two patients, additional procedures (diverticulectomy or a ureterocele incision) were performed simultaneously. Results All stones were removed intact. No serious complications were observed. The mean operative time was 46 min and the postoperative hospital stay was 22 h. The mean diameter of the largest stone and the mean stone volume of each case were 24 mm and 11 cm3, respectively. At the mean follow-up time of 15 months, there was significant improvement of the symptoms. Conclusions The T-LESS technique is an efficient, safe and minimally invasive procedure for intact bladder stone removal in selected patients. The method avoids the risk of urethral injury. Nevertheless, further investigation is needed to assess the wider applicability of the procedure.

Background Pelvic dystopia of rudimentary multicystic dysplastic kidney as a rare cause of bedwetting in children. Case presentation We report the case of a 14-year-old Kazakh girl who presented with difficulty in starting the stream of urine and intermittent interruption of the urinary stream while voiding as well as bedwetting, caused by a rare congenital disease (pelvic dystopia of rudimentary multicystic dysplastic kidney). The diagnostic workup, differential diagnosis, and management, and a review of the literature are presented. Persistent since she was 2 years old, bedwetting was stressful for both the parents and child. Initially detected radiologically and endoscopically, a bladder mass was thought suspicious for ureterocele, papilloma, or mixed tumor of the urinary bladder, but surprisingly, turned out to be a pelvic dystopia of the rudimentary multicystic dysplastic kidney. Transvesical excision of this mass was performed. Conclusions The purpose of this case report is to draw attention to the fact that a persistent case of bedwetting which does not respond to conventional therapy should be subject to further examinations to exclude surgical causes of the disease.

Bilateral ectopic ureteroceles are extremely rare. There are few reports of bilateral duplex system with ureterocele stone formation. Our case report represents a 35-year-old woman with bilateral complete ureteral duplication and stone in a right sided ureterocele. A Bugbee electrode was used to puncture the ureterocele at its most dependent part followed by fragmenting the stone using pneumatic lithotripsy. Management of the ureterocele stone depends mostly on stone size. Whereas smaller stones are amenable to endoscopic incision and lithotripsy, larger ones have required combination therapy with endoscopic incision, laser or pneumatic lithotripsy and even orificiotomy and ureterolithotomy.

We have retrospectively evaluated all patients who underwent endoscopic puncture (EP) of ureterocele over the last 26 years with special reference to the need in the second intervention and disease-free status. 78 (69%) of the 112 patients following EP and completed follow-up were included. 51 (65%) were diagnosed prenatally and 27 (35%) postnatally. 46 patients (60%) had intravesical, while 32 (40%) had ectopic ureterocele. Median age at time of puncture was 4 months. Median time of the follow-up was 12 years (range 1–26 years), while 23 (30%) followed over 10 years and 15 (19%) completed adolescent period. Four children with ectopic ureterocele required secondary puncture. Ectopic ureterocele children had significantly more postoperative UTIs (13 (40%) ectopic vs 4 (19%) intravesical p = 0.047). 19 RRUs (44%) showed spontaneous resolution of VUR. 14 (18%) children required additional surgery: 7, endoscopic correction of VUR; 3, ureteral reimplantation and 4, partial nephrectomy. The need for additional surgery following puncture was higher in the group of children with ectopic ureterocele; however, this difference did not reach a statistical significance (p = 0.716). Our data show that EP of ureterocele is a durable and long-term effective procedure in vast majority of the children.

Background: Zinner syndrome is defined as seminal vesicle cysts with ipsilateral renal agenesis and an ectopic ureter. Symptomatic cases are very rare. In this article, we present a laparoscopic approach for a case of Zinner syndrome. Case Presentation: The patient was a 21-year-old male with difficult urination. A right seminal vesicle cyst and right kidney agenesis associated with ureterocele were found on examination and he was diagnosed with Zinner syndrome. First, we performed transperineal puncture of the ureterocele because it closed the bladder neck during voiding. Although voiding symptoms temporarily improved, the ureterocele recurred soon and the urination disorder was reexacerbated. Next, we selected laparoscopic removal of the ureterocele and the seminal vesicle cyst. The procedure was performed with transperitoneal access using four trocars. Perioperative and postoperative complications were not observed, and micturition was satisfactory after surgery. Conclusion: Treatment for difficult urination because of Zinner syndrome is mostly selected puncture of the ureterocele or seminal vesicle cyst. However, some patients experience recurrence. The laparoscopic approach is minimally invasive and provides a satisfactory surgical field. Therefore, it should be considered the method of treatment for symptomatic Zinner syndrome.

Ureteral duplication is a developmental anomaly leading to many complications in children. The Weigert-Meyer law states that ‘In a complete ureteral duplication, the ureter whose orifice is more medial and caudal reaches the upper moiety and the other ureter whose orifice is more lateral and cephalad reaches the lower renal moiety’. This law has been observed universally in cases of ureteral duplication. The possible complications of double ureter and duplex system include obstruction, lithiasis, ureterocele and vesico-ureteral reflux. Hence it is important to recognize this entity for early intervention and to prevent complications. We are publishing one such rare case in a 10 month old child with review of literature.

朝日大学歯学部2018年度解剖学実習において完全型重複腎盂尿管の変異例が89歳女性（死因：心不全）の御遺体で見られたので報告する。重複尿管は人口の約0.8％で見られ亜型である完全型はさらに稀である。本例では左腎門から上下2本の尿管が骨盤腔に向かって並走し膀胱三角直前で合流していたが、尿管の開口部は2つであった。膀胱開口部近接のため重複尿管の位置関係が交差するMeyer-Weigert ruleは確認できなかった。左腎尿管はそれぞれ別の腎盂に続いていた。以上より本例は完全型の左側重複腎盂尿管であった。尿管開口部には小型膀胱内尿管瘤の形成が見られたが、異所性尿管開口は見られず、同変異が原因となった疾患の証拠はなかった。, A case of atypical complete duplicated renal pelvic ureter was found in female cadaver during anatomy dissection in 2018. Duplicated ureter originated from independent renal pelvis in left kidney which ran downward to enter into bladder. Two openings with ureterocele were so close with each other and no ectopic opening was found. Right urinary system was normal. Left kidney was heavier and longer than right one.

Introduction: Ureteroceles present a diagnostic and treatment challenge in adults (1). With an estimated prevalence of 1/500 to 1/4000, it is not uncommon for any urologist to encounter ureteroceles in clinical practice (2). The incidence of prolapsed ureteroceles in adults is unknown (3). Materials and Methods: We present an interesting case of a 53-year-old male with a 20-year history of obstructive voiding symptoms who presented with urinary retention with a Foley catheter in place. Pre-operative evaluation included a transrectal ultrasound of the prostate which revealing prostate volume of 20cc. Urodynamics revealed a high-pressure, low flow voiding pattern with a functional detrusor muscle. Cystourethroscopy was performed revealing an orthotopic ureterocele on the left side that was prolapsed into the prostatic urethra, and the bladder neck was elevated. The patient then underwent holmium laser ureterocele excision with transurethral incision of the prostate (TUIP). Using MOSES technology and laser settings of 30Hz and 1.5J, the ureterocele was completely excised and a TUIP was performed. Results: The patient was discharged home on the day of surgery with a Foley catheter in place. On post-operative day 1 he passed a voiding trial with a post-void residual volume of 25cc. Renal ultrasonography was performed 3 months postoperatively revealing no hydronephrosis. His postoperative International Prostate Symptom Score of 2 was improved compared to his preoperative score of 34. Conclusion: Holmium laser ureterocele excision with a TUIP is an effective treatment modality in the management of a prolapsed orthotopic ureterocele causing bladder outlet obstruction in a male patient.