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Highlights • Ureterocele is rare especially with collecting system duplication in the nonorthotopic (extravesical) position in adult. • Ureterocele has a variety of clinical manifestations and complications. • Endoscopic treatment was performed to decompress hydroureteronephrosis. • In this case, laparoscopy heminephrectomy is needed due to dysfunctional uppers moiety. • Renal scintigraphy is a gold standard to assess function in the duplex kidney., Introduction Ureteroceles is a developmental anomaly with cystic dilation of the distal aspect of the ureter and are often associated with some urological anomaly such as a duplicated system or stenotic ureteric orifice. Presentation of case This study reports an ectopic ureterocele in duplication of collecting system associated with double ureters and ureteral ectopia in a woman aged 24 years with minor flank pain. Cystoscopy deroofing of the ureterocele performed and followed by secondary surgery laparoscopic heminephrectomy. Discussion Ureteroceles have various clinical manifestations and complications. Treatment for ureterocele depends on age, type of the ureterocele, obstruction to the draining system, and complications. No single method is sufficient for all cases, and management must be individualized. Endoscopic treatment has gradually broadened as a safe, minimally invasive, and effective procedure, but there is no consensus on its effectiveness for treating ectopic ureterocele. However, it is reported that 50–80% of cases after initial endoscopic treatment require secondary surgery. Conclusions Ureterocele is reported rarely in adults, especially with duplication of the collection system in the nonorthotopic (extravesical) position in women. Cystoscopy deroofing of the ureterocele can be performed to decompress the hydroureteronephrosis, and laparoscopic heminephrectomy can be performed due to dysfunctional uppers moiety. Long-term follow-up is required to monitor renal function, symptoms, and occurrence of vesicoureteric reflux.

Introduction: Ureterocele is a rare urogenital malformation. The treatment is variable and complicated as it depends on several factors. The aim of this study was to evaluate the management and outcomes of children with ureterocele and to compare single system and duplex system ureteroceles. Materials and Methods: A retrospective study was conducted and all patients with ureterocele operated from January 1992 to December 2018 were included. The records of those included were assessed, and a detailed case record sheet was filled. The outcome parameters assessed were the persistence of symptoms and additional surgical procedure performed. Results: Forty-seven patients (28 boys and 19 girls) with a median age of presentation of 21 months were included. Four patients had bilateral ureterocele. Overall, 51 renal units with ureterocele were studied. Twenty renal units of the 31 renal units with duplex system underwent cystoscopic decompression, and of these, 8 (40%) needed a second procedure. Fourteen renal units of the remaining 20 renal units with single system underwent cystoscopy and decompression, and of these, 1 (7%) required another procedure (P = 0.024). Sixteen renal units had ectopic ureterocele, of which 9 (56%) underwent heminephrectomy/nephrectomy. Intravesical ureterocele was present in 35 renal units, of which only 2 (5.7%) underwent nephrectomy or heminephrectomy (P < 0.001). Conclusion: Duplex system ureteroceles are more likely to require a second procedure following an endoscopic puncture. Units with ectopic ureterocele were more likely to need nephrectomy.

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

Introduction There are no established treatments for asymptomatic ectopic ureteroceles, with completely duplicated ureters, during the neonatal period and infancy. However, conservative treatment is sometimes successful. Case presentation Two patients were prenatally diagnosed, via ultrasonography, with left hydronephrosis. In each case, magnetic resonance imaging confirmed an ectopic ureterocele accompanying the left, completely duplicated ureter. Prophylactic antibiotics were administered and conservative treatment was started. Currently, one patient is 44 months old and the other is 49 months old; in neither patient has the ureterocele or hydronephrosis been exacerbated. Conclusion Patients with (i) a nonfunctional kidney, (ii) mild hydronephrosis or moderate vesicoureteral reflux, (iii) no bladder neck obstruction on urination, and (iv) a Churchill classification ≤Grade II (Churchill classification) may be able to select conservative treatment.

Ectopic ureteroceles is sometimes noted in children as an incidental finding in antenatal ultrasonography results or because of symptoms related to a urinary tract infection. In contrast, it is rarely noted in adults, with only 18 cases in Japan presented in literature. We report here a 30-year-old adult male with an ectopic ureterocele discovered due to urination difficulty. The patient noted a poor urine stream and macroscopic hematuria after exercise, and over time needed manual compression on the lower abdomen for urination. Computed tomography results revealed a 35 mm right ureterocele containing a 7.0 mm stone. Cystoscopy showed the ureterocele protruding into the prostatic urethra, which was thought to be the cause of urination difficulty. Transurethral resection of the ureterocele and lithotripsy for the stone were performed. The right ureteral orifice was not visualized during the operation. Resection was performed from the bladder neck side so that the ureterocele wall did not interfere with urination and the calculus was crushed with a pneumatic lithotripter (LithoClast®). Urination difficulty was improved following the procedures. Urinary cystourethrography performed two weeks postoperatively confirmed no vesicoureteral reflux. No symptoms of dysuria or fever were noted at a follow-up visit two months after the operation.

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: 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

Paraurethral cysts are rare. Vaginal wall inclusion cyst, scene gland abscess, gartner duct cyst, ectopic ureterocele, periurethral fibrosis, vaginal leomyoma, urethral or vaginal neoplasm should be considered in differential diagnosis. The patient may have irritative symptoms (urinary urgency, frequent and painful urination), obstructive voiding symptoms or urinary incontinence. Physical examination is extremely important in diagnosis. Complete removal of the cyst is an effective treatment method, the risk of recurrence is low. Case report We present a 13-year-old girl with an interlabial ovoid mass with perineal pain. Physical examination revealed normal except for a 3*3 cm cystic formation in the vestibulum. There was no urinary obstruction associated. There was unremarkable in her history. No additional pathology was found in the abdominal and urinary ultrasonograhy. Urethral catheterisation was performed under anaesthesia had identified the urethral opening location, and displacement of the meatus was observed to be on the left lateral wall of the mass ( Fig. 1 ). Paraurethral cyst was totally excised ( Fig. 2 ).

Background Kidney triplication is a rare urological abnormality. Association of triplex kidney and ureterocele is out of ordinary. Treatment of such patients usually implies heminephrureterectomy of the upper moiety. We report a case of a saved function of the upper moiety after minimal invasive surgical procedure. Case presentations 5-year old girl complained for continuous wetting. Examination revealed 3 - segmented left kidney with pelvi-ureteric dilation of the upper moiety, IV grade vesicoureteral reflux in the upper moiety, cervical ectopic ureteral orifice of the upper moiety and a commune ureteral orifice of the lower segments. An endoscopic laser dissection of ureterocele was performed. Drainage of the upper moiety of triplex kidney was restored. Examination 18 months later showed no wetting and infection symptoms. Pelvi-ureteric dilation of the upper moiety and cavity of ureterocele decreased to minimal. Grade of vesicoureteral reflux decreased to I. Conclusion Minimal invasive elimination of obstruction of the upper moiety of triplex kidney was successful and led to regress of vesicoureteral reflux, urinary incontinence and let to avoid heminephrectomy.

A 5-month-old, male French bulldog was presented with a history of urinary incontinence. Abdominal ultrasound showed changes compatible with a ureterocele and a bilobed right kidney. Excretory computed tomographic urography was consistent with right-sided duplex kidney, ureter duplex and ectopic ureterocele. To the authors' knowledge, this is the first description of a duplex kidney with an ectopic ureterocele diagnosed with ultrasound and contrast enhanced computed tomography in a dog. After the imaging diagnosis, a neoureterocystostomy was performed. In the follow-up examination the dog presented with mild incontinence which was treated medically using phenylpropanolamine.Eine 5 Monate alte, männliche Französische Bulldogge wurde aufgrund von Harninkontinenz vorgestellt. Bei der Ultraschalluntersuchung des Abdomens zeigte sich eine Ureterozele sowie eine bilobulierte rechte Niere. Durch exkretorische computertomografische Urografie ließen sich rechtsseitig eine Doppelniere, ein Doppelureter sowie eine ektopische Ureterozele nachweisen. Nach Wissen des Autors ist dies die erste Beschreibung einer Doppelniere im Zusammenhang mit einer ektopischen Ureterozele beim Hund, die durch Sonografie und Computertomografie nachgewiesen wurde. Die ektopische Ureterozele wurde im Anschluss an die bildgebende Diagnostik mittels Neoureterozystostomie chirurgisch versorgt. In der Kontrolluntersuchung zeigte der Patient noch eine geringgradige Inkontinenz, die mit Phenylpropanolamin weiter behandelt wurde.

Made available in DSpace on 2021-06-25T12:32:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Background: Ureteroceles are cystic dilatations of the terminal ureter and is a rare diagnosed condition in dogs. They can be classified as orthotopic when it is entirely within the bladder and the ureteral orifice emerges normally or ectopic if the ureteral orifice is not in the normal position in the trigone. Orthotopic are usually clinically silent. Ureterocele can contribute to lower urinary tract disease leading to infections and loss of the renal function. As long as this injury can arise slowly, it might be underdiagnosed in companion animals. This case aims to report a case of a bitch with diagnosed symptomatic orthotopic ureterocele efficacious surgical treatment. Case: A 5-month-old female mixed breed was referred to the veterinary hospital, with a major complaint of urinary incontinence since the birth date after the first attendance in a colleague who have suspected of ureterocele considering ultrasound report of a vesicle of 1.4 x 1.5 cm in lefts ureter bladder's insertion topography with ipsilateral hydroureter and renal dilatation. Beside the urinary dysfunction, the animal presented good general status and normal vital signs. Complete blood count and biochemical analysis were within normal ranges. A new ultrasound exam and Computerized Urotomography with contrast gave the definitive diagnosis of left orthotopic ureterocele with twisted hydroureter (proximal 1.29 cm and distally 0.98 cm) and hydronephrosis (3.32 cm). The marsupialization was chosen scientifically based to correct the ureterocele and the patient presented good general condition since then with prompt improvement of clinical signs. The patient was submitted to serial image exams in six weeks following up to check the consequent urinary tract dilatation from the previous disease regression. After the last follow up animal received hospital discharge and was assessed twice in four months with normal measures of the urinary tract. Discussion: Different from the most common insert point of this injury, this case report presents an orthotopic ureterocele which due to the clinical signals, could be diagnosed differently from the literature who have described most often ectopic or asymptomatic events. Corroborating with usual development of uretero vesical junction obstruction described, this patient also advanced to hydroureter, hydronephrosis and kidney parenchymal loss. Due to being uncommon in small animal routine, diagnosis and therapeutic recommendations are based on few veterinarian and mainly human data. The gold-standard diagnostic method is excretory urethrocystography with an intra-bladder image called cobra-head or a contrast cystic fill defect. When ectopic ureterocele is suspected, intra-venous contrast urography or Computerized urotomography are a thrustful choice. Surgical treatment is indicated in symptomatic and obstructive ureterocele. The planning was based in urotomography diagnosis of unilateral orthotopic left ureterocele, marsupialization technique was performed. Two days after the procedure, the patient returned maintaining the total enhancement of incontinence. During the image follow up made after the surgery was observed decrease of the dilatations and improvement of renal medullary cortical ratio. This case report raises the importance of counting uncommon diseases as differential diagnosis in the veterinarian routine. Also, the use of the correct image approach can lead to the definitive diagnosis and treatment. UNESP, Sch Vet Med & Anim Sci FMVZ, Vet Surg & Anim Reprod Fac, Botucatu, SP, Brazil UNESP, Sch Vet Med & Anim Sci FMVZ, Vet Surg & Anim Reprod Fac, Botucatu, SP, Brazil

Ureteroceles are cystic dilatations of the submucosal terminal ureter that present anatomical variations, with several possible combinations of clinical and radiological presentations (uni or bilateral, orthotopic or ectopic, related to single or duplicated systems). An important concept is that ectopic and extravesical ureteroceles are not synonyms: an ectopic ureterocele may be intravesical, as the definition of ectopic ureterocele refers to any ureterocele that does not correspond to the implantation of the distal ureter in the normal site (the lateral limit of the trigonal bar). As a consequence, a ureterocele inserted near the bladder neck, for example, is ectopic, but still intravesical. The misunderstanding of this concept may cause difficulties to compare research data about ureteroceles, due to equating intravesical to orthotopic ureteroceles or to excluding intravesical ureteroceles from analyses concerning ectopic ureteroceles.

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.

Objectives Ureterocele is a sac-like dilatation of terminal ureter. Precise anatomic delineation is of utmost importance to proceed with the surgical plan, particularly in the ectopic subtype. However, the level of ureterocele extension is not always elucidated by the existing imaging modalities and even by conventional cystoscopy, which is considered as the gold standard for evaluation of ureterocele. This study aims to evaluate the accuracy of three-dimensional virtual sonographic cystoscopy (VSC) in the characterization of ureterocele in duplex collecting systems. Methods Sixteen children with a mean age of 5.1 (standard deviation 1.96) years with transabdominal ultrasonography–proven duplex system and ureterocele were included. They underwent VSC by a single pediatric radiologist. All of them subsequently had conventional cystoscopy, and the results were compared in terms of ureterocele features including anatomy, number, size, location, and extension. Results Three-dimensional VSC was well tolerated in all cases without any complication. Image quality was suboptimal in 2 of 16 patients. Out of the remaining 14 cases, VSC had a high accuracy in characterization of the ureterocele features (93%). Only the extension of one ureterocele was not precisely detected by VSC. Conclusions The results of this study suggest three-dimensional sonography as a promising noninvasive diagnostic modality in the evaluation of ectopic ureterocele in children.

Resume Une ureterocele correspond a une dilatation kystique de la portion distale, intravesicale et sous-muqueux, de l’uretere. Cet article presente un cas d’ureteroceles ectopiques bilaterales chez une jeune chienne atteinte d’incontinence urinaire, traitee par ureterocelectomie partielle bilaterale. S’il s’agit d’un cas rare, la presentation clinique est classique. Pour differencier cette affection d’une ectopie ureterale intramurale, le recours a l’imagerie, et notamment a l’echographie, est necessaire. La technique chirurgicale, simple, utilisee pour ce cas est peu rapportee dans la litterature. Elle decoule d’autres techniques decrites et de la presence ou non d’anomalie observee lors de la chirurgie, et a permis une resolution parfaite de l’incontinence urinaire de la chienne.

Introduction: Pyelonephritis is a urinary tract infection that can frequently be complicated by anatomical abnormalities such as in ectopic ureteroceles, pathologies which are rare in the literature. Case Report: A 23-year-old woman with a clinical history, physical and laboratory examinations compatible with pyelonephritis was admitted. Ultrasonography revealed a ureterocele and hydronephrosis of the upper collecting system of the left kidney. We evoked a complicated pyelonephritis and the patient underwent a computed tomography (CT) scan that confirmed bilateral pyelocalyceal and ureteral duplicity, pyonephrosis, and implantation of the upper ureter of the left kidney into the vaginal dome, forming a left ureterocele. The patient was placed on antibiotics and the ureterocele was drained through the vaginal canal. After twelve days of hospitalization, she underwent an open partial nephrectomy of the upper portion of the left kidney. On the third postoperative day, she was asymptomatic and was discharged. Conclusion: Despite the typical clinical picture of complicated pyelonephritis, this case stands out for the unusual and challenging anatomical findings, such as the pyelocalyceal bilateral duplicity and a rare infected ectopic ureterocele with vagina implantation. These challenging findings required transvaginal drainage and heminephrectomy, what shows that anatomical rare abnormalities can be hidden in a typical clinical presentation of pyelonephritis and demand an intense radiologic investigation and unusual treatments.

Summary Introduction Upper pole heminephrectomy (UHN) is performed for two main indications in children: ectopic ureterocele and duplication anomalies with upper pole ectopy, both in the context of a poorly functioning upper pole moiety. Current popular techniques for conducting UHN include laparoscopic (LPN) and robot-assisted laparoscopic (RAPN). Objective To evaluate outcomes following dorsal lumbotomy (DL), an open approach used historically for pyeloplasty and pyelolithotomy, and in which no clinical trials or exclusive case-series have been conducted for upper pole hemi-nephrectomy (UHN) in children. We ultimately aim to compare our outcomes following DL at our centre to that of published outcomes of minimally invasive approaches to UHN. Study design Institutional board review was obtained (H18-03716) for a retrospective review of 50 UHN performed in 49 consecutive pediatric patients using the DL approach by a single surgeon between 2001 and 2019. Clinical variables and indicators included age, sex, weight, skin-to-skin time, total operating room time, duration of hospital stay, post-operative complications, analgesic requirements, and post-operative ultrasound results. Results Of 50 UHN performed, 23 had a presurgical diagnosis of ectopic ureter, and 27 ureterocele. Mean weight of patients was 12.61 kg, and the mean age at surgery was 24.55 months. Mean (range) for time between skin incision and closure was 88.5 (62–132) minutes, and the mean (range) total operating room time was 138.5 (70–180) minutes. There were neither intraoperative complications nor transfusions. The mean (range) post-operative opioid delivered was 0.73 (0.00–2.00) mg/kg/day. Mean (range) post-operative ibuprofen delivered was 5.41 (0.00–37.73) mg/kg/day. Median length of hospital stay was 2 days. No patient received post-operative prescriptions for narcotics at discharge. There were no wound complications. One patient had secondary atrophy of the lower pole. Secondary lower tract surgery, unrelated to surgical approach, was performed in five patients. Ten patients experienced a urinary tract infection at some point after surgery. Conclusion DL is safe, feasible, and produces operative outcomes and times comparable to that of laparoscopic and robotic techniques. These findings as well as operative costs should be considered when selecting a surgical technique for UHN. Summary . Patients' demographics, operative and post-operative characteristics Age, months, mean ± SD (range) 24.55 ± 24.00 (5–132) Weight, kg, mean ± SD (range) 12.61 ± 5.35 (6.90–31.00) Time between skin incision and closure (skin-to-skin), min 88.51 ± 16.79 (62–132) Total operating room time, min 138.46 ± 24.60 (70–180) Length of hospital stay, days 2.55 ± 0.74 (2–5) Follow-up, months 22.25 ± 35.88 (1.70–179.03) Post-operative opioid (mg/kg/day) 0.73 ± 0.44 Post-operative acetaminophen (mg/kg/day) 66.51 ± 21.03 Post-operative ibuprofen (mg/kg/day) 5.41 ± 9.72 Values are described as “mean ± standard deviation (range, if applicable)”.

Summary Introduction To date, the optimal surgical technique for ureterocele complex remains unclear and a diverse range of management options have been suggested. Some endoscopic approaches share major drawbacks such as de novo vesicoureteral reflux (VUR) into ureterocele moiety that can mandate revision surgery. Objective In this study, long-term outcomes of double-puncture technique are evaluated. Material and methods Records of patients treated by double-puncture technique between 1999 and 2014 were reviewed. Patients with a history of previous ureterocele surgery, follow-up period of less than two years, or an orthotopic ureterocele were excluded. In this technique, a double-J stent is inserted into two punctured sites at the poles of an ectopic ureterocele. Subsequently, anterior and posterior collapsed walls of a ureterocele were fulgurated at multiple points to create surface welding of the urine channel. Follow-up data regarding success of ureterocele decompression, de novo VUR, febrile urinary tract infection (UTI), and the need for further intervention were recorded. Results Forty-eight patients (51 ureteroceles) were assessed in this study. Bilateral ureterocele double puncture was performed for three patients (6.3%). Mean (range) age at the time of surgery was 2.9 (2 months–13 years) years. Mean follow-up was 6.1 (2–15.2) years. Successful decompression was achieved in all except two ureteroceles (success rate = 96.1%) (Summary Figure). New-onset VUR to punctured moiety was diagnosed in another two patients. No postoperative febrile UTI was encountered. Conclusions Double-puncture technique is a successful endoscopic intervention for immediate and durable decompression of ectopic ureteroceles without incurring major complications. Download : Download high-res image (505KB) Download : Download full-size image Summary Figure . Complete collapse of a 17.6 mm × 9 mm ureterocele at right ureterovesical junction following double puncture technique (A, B, C). The double-J stent is evident inside the collapsed ureterocele four weeks postoperatively. A significant decrease in right upper pole hydronephrosis is achieved during the course of follow up (D, E, F).

Ectopic ureter and ureterocele are rare congenital anomalies. As such, are seldom encountered incidentally during urologic surgery. We present a case illustrating an unforeseen encounter of an ectopic ureter with an associated ureterocele during a robotic assisted laparoscopic prostatectomy (RALP) and the surgical technique used to adapt to the anatomical variation.

A cecoureterocele is a rare form of ectopic ureterocele that the orifice of the affected ureter is within the bladder, but the cavity of the ureterocele extends beyond the bladder neck into the urethra. We present a case of a newborn boy with a large cecoureterocele with contralateral renal rupture. He required an emergency transurethral incision of the ureterocele for the treatment of acute renal failure and respiratory disorder.

Objective To clarify the impact of endoscopic incision for ureterocele as an initial procedure, retrospective chart review was performed focusing on the prevalence and risk factors of symptomatic urinary tract infection after endoscopic incision. Materials and methods Among children with ureterocele who were managed between September 1994 and April 2016, patients who were observed conservatively without additional surgical management after endoscopic incision were included in this study. Type of ureterocele was divided into intravesical and ectopic. Symptomatic urinary tract infection was defined as either recurrent non-febrile or febrile urinary tract infection. Statistical analysis was performed using the Cox proportional Hazard model or Kaplan-Meier Curve with log-rank test for evaluation of the prevalence and risk factors. Results Thirty-six patients met the inclusion criteria. Median age at endoscopic incision was 8.9 months. Eleven children had symptomatic urinary tract infections (febrile in 9 and recurrent non-febrile in 2) during median follow-up of 75.5 months. Initial symptomatic urinary tract infection in each child occurred within 25 months after endoscopic incision. Symptomatic urinary tract infection-free rate after endoscopic incision was 65.6%. The risk factors for symptomatic urinary tract infection were female gender, duplex system, ectopic ureterocele, and unchanged hydronephrosis after EI. Conclusions The current study demonstrated the critical period and risk factors for symptomatic urinary tract infection after endoscopic incision for the treatment of ureterocele. These results suggest that when conservative management is indicated after endoscopic incision, patients, especially those with risk factors, should be followed carefully at least for 25 months after endoscopic incision for symptomatic urinary tract infection. This article is protected by copyright. All rights reserved.