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Relevance. The article is devoted to an important problem of urology - ureterocele (UC), as the most common malformation of the terminal part of the ureter, with the subsequent formation of a cyst causing urodynamic disturbances. A retrospective analysis of the results of surgical treatment of 67 children diagnosed with ureterocele for the period from 2010 to 2023 was carried out. All children were divided into two groups: the main group, in which the TURU method was used, and the control group, in which three types of surgical approaches were used with complete removal of the ureterocele. In the late postoperative period, repeated surgery was performed 1.6 times more often in the control group. The most significant reoperation was nephrectomy. Depending on the method of surgical treatment, all children were divided into 2 groups - main (38 children) and control (29 children). Age and sex were not taken into account when dividing the children into groups. The division of children into groups was based on the use of different methods of surgical treatment of ureterocele, regardless of the frequency of congenital concomitant pathology and complications. Children with ureterocele should undergo early surgical treatment in order to unload the upper urinary system and prevent further progressive damage. A safe and minimally invasive choice of surgical treatment of UC is TURU operation as an organ-saving and highly effective method of decompression and restoration of normal urinary tract urodynamics. [ABSTRACT FROM AUTHOR]

Ureteroceles are often diagnosed antenatally and incidentally and treated in a minimally invasive fashion with endoscopic puncture. Recent literature suggests that observation, or non-operative management, is an effective and viable management option in select patients with ureteroceles and certain radiologic findings, however there is no consensus on how to best select patients for non-operative management. To 1) determine if pediatric ureteroceles managed non-operatively require less or sooner secondary surgical intervention than those managed with up-front incision, 2) describe characteristics of success and failure in pediatric ureteroceles managed non-operatively, and 3) identify risk factors associated with receiving intervention and time to intervention. Of 287 ureteroceles, 65 (23%) were managed non-operatively and underwent secondary surgical intervention less frequently (9% vs. 34%, P < 0.01) and later (median age 40 vs. 20 months) than those managed with puncture. Successful non-operative management was associated with fewer comorbidities, smaller ureterocele size, absence of vesicoureteral reflux (VUR) and high-grade VUR, single collecting system, lesser degree of hydronephrosis, ipsilateral MCDK and intravesical location. For all ureteroceles, high-grade VUR, duplex system, and female sex were associated with shorter time to secondary intervention (intervention after initial management). In the largest retrospective review of ureterocele management, smaller ureterocele size, absence of high-grade VUR, single system, ipsilateral MCDK and minimal hydronephrosis were factors that increased the efficacy of non-operative management of select pediatric ureteroceles. Furthermore, time to event analysis showed that non-operative management did not predispose patients to sooner secondary intervention (Figure). Lack of a standardized protocol for ureterocele management is a limitation of this single institution retrospective study as it introduces selection bias to the results, however few patients with low risk characteristics underwent puncture and no high risk patients were observed. Smaller ureterocele size, absence of high-grade VUR, single system, ipsilateral MCDK and minimal hydronephrosis are factors that may increase the efficacy of non-operative management of select pediatric ureteroceles, which may delay or avoid secondary surgical intervention. [ABSTRACT FROM AUTHOR]

To assess the results of endoscopic ureterocele treatments as well as the effects of ureterocele location (intravesical vs. ectopic) and anatomy (single vs. duplicated system) on treatment outcomes. Following the Systematic Reviews and Meta-Analyses (PRISMA) standards, several medical databases as well as Google Scholar were searched comprehensively. Studies describing secondary operation outcomes for endoscopic transurethral incision and puncture were included. Studies were required to compare patients according to ureterocele location (intravesical or ectopic) and anatomy (single or duplex system) or preoperative reflux. Meta-analysis was conducted using Comprehensive Meta-analysis (CMA) software. A total of 83 studies entered this systematic review consisting of 3022 patients. According to the meta-analysis of 16 studies, the risk ratio (RR) of reoperation after ureterocele incision was significantly higher in patients with ectopic vs. intravesical ureteroceles (RR: 2.42; 95% CI: 1.89–3.11; P < 0.001; I2: 14.89%). Also, a higher reoperation rate was reported in patients with duplex system ureteroceles (DSU) vs. single system ureteroceles (SSU) with little heterogeneity based on 9 studies. (RR: 2.50; 95% CI: 1.60–3.91; P < 0.001; I2: 13.83%). Our results showed that ectopic ureteroceles and duplex systems are associated with higher reoperation rates after endoscopic procedures. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to assess the diagnostic efficacy of contrast-enhanced voiding urosonography (ceVUS) using SonoVue for evaluating duplex kidneys, and to compare it with fluoroscopic voiding cystourethrography (VCUG). Material and methods: Forty-six children with duplex kidneys confirmed by surgical intervention or cystoscopy were included in the study, resulting in a total of 46 duplex kidneys and 46 normal kidneys (138 pyeloureteral units). Results: The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RBUS for diagnosing duplex kidney disease were 73.91%, 80.43%, 79.07%, and 75.51%, respectively. The diagnostic performance of RBUS and ceVUS in detecting duplex kidney yielded an overall sensitivity, specificity, PPV, and NPV of 89.13%, 84.78%, 85.42%, and 88.64%, respectively. The sensitivity, specificity, PPV, and NPV of VCUG in diagnosing duplex kidney disease were 17.31%, 86.96%, 57.14%, and 51.23%, respectively. For the 42 pyeloureteral units with VUR, Cohen's weighted kappa value for the agreement between ceVUS and VCUG in grading VUR was 0.702 (95% CI, 0.551 ~ 0.854; p <0.05). Conclusions: RBUS effectively diagnoses duplex kidneys with renal pelvic dilation, while ceVUS can further elucidate whether reflux occurs in the upper or lower moiety in cases of duplex kidneys with VUR. Compared to VCUG, both RBUS and ceVUS provide more intuitive diagnoses for duplex kidneys with VUR and ureterocele. Additionally, there is good consistency between ceVUS and VCUG in grading VUR. CeVUS is recommended as an initial evaluation method for patients suspected of having duplex kidneys associated with urinary tract infections. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to retrospectively evaluate postoperative results of patients with duplex system ureterocele (DSU) who underwent endoscopic ureterocele incision (UI), lower urinary tract reconstruction (LUTR) or both, and investigate the necessity of upper pole heminephrectomy (UPH) in ureterocele treatment. Patients and methods: In total, 44 patients with DSU who were operated on in December 2005 and December 2018 were evaluated for patient characteristics, ureterocele location, differential renal function (DRF), vesicoureteral reflux (VUR), postoperative incontinence, proteinuria, hypertension and urinary tract infection (UTI). Results: UI was performed in 27 of 44 cases (61.3%) as the first-line treatment. Ten of them (37%) had no urinary infection or renal function loss at a mean of 3 years (1.5–7 years). LUTR was needed in 17 patients after UI due to VUR in 14 patients and bladder outlet obstruction (BOO) in 3 patients. In total, 34 patients who underwent LUTR, proteinuria or incontinence were not detected in the mean 6 years' follow-up. Thirty-three patients (97%) had identical renal scans and similar DRF before and after the operation. No patient underwent UPH. Conclusion: UI must be considered the first-line treatment in DSU in infancy. In older patients, especially with VUR, LUTR is effective and safe and UPH mostly is not necessary. Level of evidence: 4 [ABSTRACT FROM AUTHOR]

Objective: To assess the role of voiding cystourethrography (VCUG) in patients with duplex system ureterocele (DSU) undergoing endoscopic decompression (ED). Materials and methods: This is a retrospective study of 75 consecutive patients with DSU undergoing ED [median (range) age, 6 (1–148) months]. Patients were divided into 3 groups, 33 with a VCUG showing vesicoureteral reflux (VUR) before ED (VUR-group), 22 with a VCUG negative for VUR (No-VUR-group), and 20 who did not undergo a VCUG (No-VCUG-group). Secondary surgery (SS) rate was compared among groups. Results: Groups were comparable for baseline characteristics. SS rate was 82% (27/33) in VUR-group vs. 32% (7/22) in the No-VUR-group (p = 0.0001), and 25% (5/20) in the No-VCUG-group (p = 0.001 vs. VUR-group, and 1 vs. No-VUR-group). In the VUR-group, 9 patients underwent preemptive endoscopic treatment of VUR during ED and SS rate was 44% (4/9) vs. 96% (23/24) in the remainder, p= 0.003. In the No-VCUG-group, a VCUG was performed during follow-up in 9/15 patients and showed reflux in all, although only 2 of these developed a (single) urinary tract infections. Conclusions: SS rate was significantly higher in patients with preoperative VUR. Instead, it was not significantly different between patients without VUR and those who did not undergo a VCUG before ED, despite all the latter who underwent a VCUG during follow-up had evidence of VUR generally in the absence of symptoms. In our opinion, a VCUG could be limited to patients developing symptoms after ED. If a VCUG is performed before ED, a preemptive treatment of VUR should be taken into consideration. [ABSTRACT FROM AUTHOR]

Ureteroceles are the most prevalent urinary tract malformations in humans. Only 5% of ureteroceles are predicted to prolapse and it usually occurs in childhood. We outline the clinical history, radiological results, and a potential course of treatment for this challenging condition. A 32-year-old female checked herself into our institution with complaints of burning urination and 20 years of complaints of urethral ballooning when urinating. Initial sonographic evaluation revealed that at the left vesicoureteric junction, a cystic lesion extends into the bladder, with a hyperechoic focus causing posterior acoustic shadowing. CT scan confirmed the diagnosis of an ureterocele with calculus. A voiding cystourethrogram revealed a left-sided ureterocele that descends down the urethra and into the interlabial region. CT cystogram verified the presence of a left-sided cecoureterocele with calculus. Cecoureterocele is a rare variant of ectopic ureteroceles. Girls experience this condition more frequently than boys, and they are predisposed to vesicoureteric reflux and recurrent infections. To prevent problems like renal function loss, recurrent urinary tract infections, and urinary incontinence, it is important to gain diagnostic confirmation of these circumstances. Less invasive surgical techniques like endoscopic ureterocele puncture or even nonoperative treatment appear to produce comparable functional outcomes. When a patient arrives with a urethral protrusion, one should be extra cautious. In this case report, a cecoureterocele that has prolapsed is presented in a rare way. It presents an important chance to evaluate the clinical and diagnostic characteristics of this urinary tract abnormality.

The possibility of solving a bulky uretererocele in childhood. We present a case report of a boy who was operated on at our institution for ureterocele with multiple ureterolithiasis. [ABSTRACT FROM AUTHOR]

An intravesical ureterocele is a rare condition in which a terminal ureter terminates in a cystic dilation of the bladder. We present the case of a 42-year-old female who presented with irritative lower urinary tract symptoms and left lower back pain. Computed tomography (CT) urography revealed ureteral duplication with a ureterocele complicated by upper tract obstruction. Treatment involved endoscopic ureterocelotomy, which successfully relieved symptoms and resolved renal obstruction. [ABSTRACT FROM AUTHOR]

Purpose of Review: In this study, we describe a rare case of a male with a duplex renal collecting system with ectopic ureter insertion into the prostate who presented with sepsis and required urgent laparoscopic radical nephrectomy. This study offers urologists and emergency care practitioners a great overview of the variety of manifestations, anatomic differences, and therapeutic approaches for similar patients. Recent Findings: modified reconstructive strategy could be a method of choice when addressing particular anatomies, such as incomplete duplex kidneys with ureteropelvic junction obstruction in both upper and lower poles when the obstruction is close to the confluence of the two ureters. Summary: There is a spectrum of acute presentations and management strategies in adult patients with duplex collecting systems. The majority of patients presenting with obstruction and infection are managed surgically with hemi-nephrectomy; stable patients who present with less extensive anomalies were managed conservatively or with ureteral dilatation or deroofing. [ABSTRACT FROM AUTHOR]

Background: Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known about long-term outcomes and quality of life (QoL) for these patients. Objective: To present long-term outcomes and QoL data up to 30 yr after surgical treatment of duplex kidneys and associated pathologies. Design, setting, and participants: We collected clinical and operative data for all patients who underwent surgery for complicated duplex kidney at our institution from 1990 to 2018. All patients were invited for a follow-up examination or telephone interview. Outcome measurements and statistical analysis: We evaluated renal function, clinical outcomes, residual dilation of the upper urinary tract, and health-related QoL. Results and limitations: Of the 176 patients included, 173 were available for follow-up (mean 140.5 mo). Surgical treatment involved an upper-tract, lower-tract, or combined approach in 11%, 56%, and 33% of cases, respectively. Rates of perioperative complications (8%) and secondary surgery (10%) were low. Overall, 95% of our patients achieved full restitution. Renal function was preserved in all cases, with recurrent urinary tract infections reported by just 2% and urinary incontinence by 1%. Good health-related QoL was reported by 98% of patients. Those without full restitution included six patients who underwent total nephrectomy and two boys who underwent multiple surgeries and urinary diversion. Our results are limited by their retrospective nature, including partly incomplete data sets. Conclusions: Management of duplex kidneys and associated pathologies is complex and highly individual. By planning a personal approach for each patient it is possible to achieve full bodily integrity and good QoL for most of these patients. Patient summary: Almost all patients undergoing surgery for duplex kidneys and associated pathologies will lead a life without body impairment and good quality of life.This trial is registered in the German Clinical Trials Register as DRKS00022542.

Introduction: Ureterocele is a congenital malformation of the urinary tract, characterized by the cystic dilation of the terminal ureter. Its treatment is indicated in symptomatic patients. Over the years, surgical treatment has evolved from open surgeries to minimally invasive procedures. The aim of this study was to assess the long-term outcomes of a case series involving pediatric patients with ureterocele, who were treated using an endoscopic puncture. Material and methods: A retrospective review was performed of ureterocele patients treated by endoscopic puncture from 2002 to 2021. The primary outcome of the study was relief of the obstruction with a single endoscopic puncture. Results: From 2002 to 2021, a total of 34 patients with 39 ureteroceles underwent treatment using this technique. The mean age at diagnosis was 16 months. Diagnoses was made prenatally through an ultrasound revealing a dilated urinary tract in 17/34 (50 %) of patients and during the assessment of a urinary tract infection in 15/34 (44 %) of patients. A duplex collecting system was observed in 28/34 (82 %) of patients, while bilateral ureteroceles were found in 5/34 (15 %) of patients. A single endoscopic puncture of the ureterocele proved to be successful in 27/34 (79 %) of patients. A second endoscopic puncture was needed in 4/34 (12 %). Only 3/34 (9 %) patients required a surgical intervention. The mean follow-up period was 4 years. Conclusion: The results of our study show that endoscopic puncture of obstructive ureterocele is a procedure with excellent long-term results.

Purpose: The aims of this study were to analyze the clinical outcomes of treating duplex system ureteroceles with early endoscopic puncture decompression and to identify the risk factors related to outcomes to help guide future work. Materials and methods: We retrospectively reviewed the clinical records of patients with ureteroceles with duplex kidney that were treated with early endoscopic puncture decompression. Charts were reviewed for demographics, preoperative imaging, surgical indications, and follow-up data. Recurrent febrile urinary tract infections (fUTIs), de novo vesicoureteral reflux (VUR), persistent high-grade VUR, unrelieved hydroureteronephrosis, and the need for further intervention were considered unfavorable outcomes. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), type of ureterocele, ipsilateral VUR diagnosed before surgery, simultaneously upper-pole moiety (UM) and lower-pole moiety (LM) obstruction, the width of ureter affiliated to UM, and maximum diameter of ureterocele were all considered potential risk factors. A binary logistic regression model was used to identify the risk factors of unfavorable outcomes. Results: A total of 36 patients with ureteroceles related to duplex kidney underwent endoscopic holmium laser puncture from 2015 to 2023 at our institution. After a median follow-up of 21.6 months, unfavorable outcomes developed in 17 patients (47.2%). Three patients underwent ipsilateral common-sheath ureter reimplantation and one patient underwent laparoscopic ipsilateral upper to lower ureteroureterostomy combined with recipient ureter reimplantation. Three patients underwent laparoscopic upper-pole nephrectomy. Fifteen patients suffered from recurrent UTIs were treated with oral antibiotics and eight of them were diagnosed de novo VUR according to voiding cystourethrography (VCUG). In univariate analysis, patients with simultaneously UM and LM obstruction (P = 0.003), fUTIs before surgery (P = 0.044), and ectopic ureterocele (P = 0.031) were more likely to have unfavorable outcomes. Binary logistic regression analysis showed that ectopic ureterocele (OR = 10.793, 95% CI 1.248–93.312, P = 0.031) and simultaneously UM and LM obstruction (OR = 8.304, 95% CI 1.311–52.589, P = 0.025) were identified as independent factors for unfavorable outcomes. Conclusions: Our study suggested that early endoscopic puncture decompression is not a preferred but an available treatment option to release BOO or to cure refractory UTIs. It was easier to fail if the ureterocele was ectopic or simultaneously UM and LM obstruction existed. Gender, age at surgery, BMI, antenatal diagnosis, fUTIs, bladder outlet obstruction (BOO), ipsilateral VUR diagnosed before surgery, the width of ureter affiliated to UM, and maximum diameter of ureterocele were not significantly related to the success rate of early endoscopic punctures. [ABSTRACT FROM AUTHOR]

Background. Ureterocele is a cystic dilatation of the distal ureter. Orthotopic ureterocele is relatively rare form of this disease, and it is commonly diagnosed in female children. The clinical picture of orthotopic ureterocele is usually not significant, and the management variants are unclear. Clinical case description. Ultrasound has revealed dilatation in the distal part of the left ureter (up to 6.5 mm) and cyst formation (diameter of 8 mm, thick walls) in the bladder in 8-months-old boy. The retrograde voiding cystourethrogram has shown no signs of vesicoureteral reflux. The evaluation of the voiding rhythm was performed: the volume of residual urine was > 30%, it indicates the infravesical obstruction. The child underwent diagnostic cystourethroscopy, transurethral resection of the ureterocele, intubation ureteral catheter in the left ureter (all procedures was performed under general anesthesia). There were no enlargements of calices-pelvis system and ureters 12 months after surgery according to urinary system ultrasound. Clinical urine test with no inflammatory changes. Voiding rhythm was without pathology.Conclusion. The widespread implementation of high-tech and minimally invasive methods of diagnosis and management allow us to achieve timely detection and provide effective treatment for children with ureterocele.

Abstract Background Duplex kidney is a relatively common renal anomaly with a wide array of associations. With routine antenatal screening it is increasingly diagnosed these days. With this study, we aim to assess the clinical profile, prevalence of vesicoureteric reflux and highlighting the need for aggressive workup and management in selected cases to prevent further renal damage. Results Fifty-three children with duplex kidneys who attended the department of pediatric surgery at our institution from December 2016 to December 2021 were included in the study. The most common mode of presentation was urinary tract infection (58%). Fifty-three percent had an antenatally detected renal anomaly (out of these 46% were asymptomatic, 33% had UTI and 11% had other symptoms like straining, incontinence and abdominal mass). Sixty-one percent of patients were conservatively managed and 19 patients needed surgical intervention. Ureterocele was the most common condition necessitating surgery. Prevalence of vesicoureteric reflux was 60% and was comparable with other studies. Thirty-six percent of patients had renal scarring. Among the patients with scarring, 84% had VUR and 63% had febrile UTI. Conclusion Duplex kidney though a common congenital anomaly, requires a systematic evaluation to detect its various associations and a structured management protocol according to the associations. It has a high incidence of VUR which is a potentially hazardous condition which can affect the renal function if not evaluated and managed appropriately. Duplex can also be associated with obstructive conditions like PUJO, ureterocele, and ectopic megaureter which can cause rapid deterioration of renal function if not managed early enough. Though majority of the patients need only follow-up and antibiotic prophylaxis, there may be a certain sub group of patients who develop early scarring and need aggressive management. Our study aims to highlight the need to detect such patients early enough to reduce the morbidity.

Hydrosalpinx is a common condition in women of reproductive age that correlates with infertility. A ureterocele is a dilatation of the terminal ureter within the bladder and/or urethra that occurs seldomly in adults, but can sonographically be mistaken for a hydrosalpinx. We report of a 29-year-old patient (G2/P1) who was referred in our department with secondary infertility and suspicion of hydrosalpinx. Intraoperatively, no hydrosalpinx could be visualized. Postoperatively, an intravesical cystic mass was detected, alongside a second-degree urinary retention. Sonographically, a double kidney on the left side and an accentuated calyx system could be diagnosed. Ureteroceles seem to represent a rare but still possible differential diagnosis in suspected hydrosalpinx, given the similar sonographic presentation of both conditions. [ABSTRACT FROM AUTHOR]

Aim: The presence and clinical importance of vesicoureteric reflux in patients with a double collecting system are being questioned. Therefore, the role of voiding cystourethrography in the management of patients with ureterocele is unclear. This study aimed to evaluate patients with a ureterocele in terms of urinary tract infection (UTI) and vesicoureteral reflux (VUR). Material Methods: The cases who were admitted to the Pediatric Nephrology Clinic of Health Sciences University Tepecik Training and Research Hospital between 2012 and 2022 and were diagnosed with ureterocele were evaluated retrospectively. Demographic, clinical, and laboratory data were obtained from file records. Results: All patients diagnosed with ureterocele and voiding cystourethrography (VCUG) were evaluated. A total of 24 (female 13 (54.2%)) children were included. The reasons for admission were antenatal hydronephrosis in 13 (54.2%) patients, UTI in 9 (37.5%) patients, and incidentally diagnosed ureterocele in 2 (8.3%) patients. Urinary tract infection was observed in 20 patients at admission, recurrent UTI in 21 patients at follow-up, preoperative pyelonephritis in 12 patients. VUR was found in 11 patients, and severe VUR (≥stage 3) was found in 9 patients. Ten patients had ipsilateral hydronephrosis, and 14 patients had a double collecting system. The presence of VUR was found to be associated with female gender, UTI at admission, and recurrent UTI at follow-up (p < 0.05). However, there was no difference between groups with or without VUR in terms of ipsilateral hydronephrosis, scar formation, and the need for surgery (p > 0.05). Conclusions: We could not demonstrate any criteria to select patients to receive VCUG; on the other hand, VUR did not cause more kidney damage. Our study supports the need for more scientific data to determine management in patients with ureterocele.

Congenital renal anomalies are among the most common birth defects. They are often detected antenatally. If not, they can manifest in adulthood with variable clinical presentations. Herein, we present a case of a 72-year-old male patient who was incidentally found to have an extremely rare combination of urinary tract defects comprising: right-sided unilateral renal agenesis, blind ureter, and ectopic ureterocele.

Ureterocele is a cystic dilatation of the intravesical submucosal ureter, with an obstructed orifice. Endoscopic treatment is one of the most common option for surgical treatment. In intravesical ureterocele, the punctures must be made just above the junction between the ureterocele and the bladder floor. We commonly use a 8–9.8 Fr cystoscope, with a 5 Fr working channel, a metallic needle for bulking agent injection 3.7 Fr. In selected cases we also use electric or laser probes to decompress the ureterocele. When evidence of decompression is verified and vesicoureteral reflux is excluded, antibiotic prophylaxis is stopped. If, despite decompression, a large ureterocele is subsequently obstructing the bladder neck a surgical excision is necessary. Forty-four patients (92%) were treated endoscopically. Ureterocele puncture was performed with a metallic needle for bulking agent injection in 30 cases (63%), with a laser fiber in 7 cases (15%), with an electrified ureteral catheter in 4 cases (8%), and with Bugbee in 3 cases (6%). A success rate after one procedure was achieved in 40 children (83%). Adequate opening of the ureterocele with complete decompression of the reno-ureteral system is the goal of endoscopic treatment. An overaggressive incision or puncture could result in an increased chance of secondary vesicoureteral reflux. [ABSTRACT FROM AUTHOR]

Purpose: Ureterocele has been hypothesized to be the risk factor for febrile urinary tract infections (F-UTIs) in patients with duplex collecting systems, but this has not been proved, and our goal was to assess the relation between ureterocele with duplex collecting systems and F-UTIs. Methods: We included individual-participant data from patients seen for complicated duplex collecting systems from 2010 to 2020 retrospectively followed. Those with using continuous low-dose antibiotic prophylaxis and incompletely duplicated systems were removed from the study. The participants were divided into two cohorts according to patients with or without ureterocele. The primary endpoint of this study was recurrent F-UTIs. Results: We analyzed medical reports of 300 patients, of which 75% were female. Among the 300 patients, F-UTIs developed in 111/159 (69.8%) patients in the ureterocele group and in 69/141 (48.9%) patients in the no-ureterocele group. Univariate analysis found no discernible difference except in grade of hydronephrosis between ureterocele group and no-ureterocele group. Moreover, Cox proportional regression analysis revealed that patients of duplex system ureterocele might be intrinsically more prone to develop F-UTIs (adjusted hazard ratio 1.894; 95% CI 1.412–2.542; p < 0.001). Conclusion: Among participants with duplex systems, the risk of recurrent F-UTIs in patients with ureterocele was higher than patients without it, and mini-invasive surgical correction should be considered at young age to reduce F-UTIs. [ABSTRACT FROM AUTHOR]

Objective. To assess the efficacy of the endourological treatment of ectopic ureterocele in children in a large series and with a long-term follow-up. Materials and methods. A retrospective, descriptive study of patients with ectopic ureterocele who had undergone surgery in our institution in the last 15 years was carried out. All patients were treated using an endourological approach, both for ureterocele and postoperative vesicoureteral reflux (VUR). Results. 40 patients were treated -55% with left involvement and 5% with bilateral involvement. Mean age at diagnosis was 4.97 months, with diagnosis being established prenatally in 54.1% of cases. In all patients but one, endourological puncture of the ureterocele was conducted. Mean age at surgery was 6.96 months (0-1.11). Surgery was performed on an outpatient basis in 94.9% of patients. No perioperative complications were recorded. In the last 30 patients, preoperative voiding cystourethrography was not carried out. 72.5% of patients had postoperative VUR (44.8% into the upper pyelon, 10.3% into the lower pyelon, 17.2% into both, 6.9% into the contralateral system, and 20.7% into the bilateral system), but it was resolved with a single endoscopic procedure in 48.1% of cases (65% of patients were healed with two procedures). VUR was not endoscopically resolved in 3 patients who required ureteral re-implantation. 6 patients required heminephrectomy (n=3) or nephrectomy (n=3) as a result of functional impairment and infections. Conclusion: The endourological treatment of ectopic ureterocele is a little aggressive and little invasive technique that allows the obstruction to be resolved on an outpatient basis, which means bladder surgery -if required- can be performed outside the neonatal period. [ABSTRACT FROM AUTHOR]

Ureterocele is rare urinary malformation. We reported a 12-month-old girl case with a prolapsed ectopic ureterocele in the vulva. Urinary catheterization was used as an emergency treatment to minimize the ureterocele. The patient later benefited from an upper polar hemi-nephrectomy, which helped to resolve the issue partially. She sought treatment for the prolapse again a Three month later, this time ureterecelectomy with ureteral reimplantation was employed. The non-consensual management of this malformation must be initiated as soon as possible to prevent complications. The first treatment goal was to decompress the prolapsed ureterocele and remove it endoscopically.

Introduction Incomplete sagittal septum of the urinary bladder is an extremely rare congenital anomaly and one of the variations in bladder duplication. Herein, we report a case of incomplete sagittal septum of the bladder with cystolithiasis. Case presentation A 20‐year‐old man was referred to our department for examination and treatment of symptomatic cystolithiasis and a suspected giant ureterocele on the left side. Cystoscopy and urography performed under general anesthesia revealed anatomical structures suggestive of the sagittal septum of the bladder. Subsequently, transurethral septostomy and cystolithotripsy were performed. The detrusor muscle was microscopically identified, leading to the diagnosis of an incomplete sagittal septum of the bladder. Conclusion Although extremely rare, an incomplete sagittal septum of the bladder may be difficult to differentiate from a ureterocele, and should be considered when a large cystic lesion is found in the bladder.

Ureterocele, a type of ectopic ureter characterized by cystic dilation of the distal ureter, can sometimes contain stones. Here, we present the case of a 67-year-old woman who was under observation for ureteral stone and experienced spontaneous ureterocele wall ruptured due to the stone. As illustrated in the present case, conservative observation, which is recommended as initial management of stones in ureterocele to reduce the risk of vesicoureteral reflux following transurethral ureterocele incision, may be associated with increased risk of ureterocele wall rupture and subsequent vesicoureteral reflux.

Introduction Obstructive ureterocele is an intravesical cystic dilation of the distal end of the ureter associated with anhidramnios and dilation of both renal pelvises. Methods This is a case-series of prenatally diagnosed ureterocele. Cases were selected at a third level reference hospital in Monterrey Mexico between 2010 and 2018. Eligible patients for fetal therapy were selected when bilateral hydronephrosis and severe oligohydramnios were found before 26+0 weeks of gestation. The fetal intervention comprised an ultrasound-guided needle laser technique for ureterocele ablation. Results There were six cases of prenatal diagnosed of ureterocele, two cases showed anhidramnios at 23 weeks of gestation and were considered obstructive ureterocele. For these two cases, fetal surgery was performed using laser ablation of the ureterocele through an ultrasound-guided needle. In both, the urinary tract was decompressed, and the volume of amniotic fluid improved allowing to carry both pregnancies until term, one of them vaginally and the other by cesarean section. In the postnatal follow-up of both cases, the first neonate died due to neonatal asphyxia at 48-hours, and the second neonate required removal of the abnormal collecting system. Conclusions The use of ultrasound-guided laser ablation for the decompression of obstructive ureterocele is a safe and feasible technique in extremely premature fetuses that could allow survival of the affected fetus until term. Patients receiving an early prenatal diagnosis of obstructive ureterocele may benefit from fetal therapy to reduce the risk of lung hypoplasia and stillbirth. [ABSTRACT FROM AUTHOR]

Aim: The presence and clinical importance of vesicoureteric reflux in patients with a double collecting system are being questioned. Therefore, the role of voiding cystourethrography in the management of patients with ureterocele is unclear. This study aimed to evaluate patients with a ureterocele in terms of urinary tract infection (UTI) and vesicoureteral reflux (VUR). Material Methods: The cases who were admitted to the Pediatric Nephrology Clinic of Health Sciences University Tepecik Training and Research Hospital between 2012 and 2022 and were diagnosed with ureterocele were evaluated retrospectively. Demographic, clinical, and laboratory data were obtained from file records. Results: All patients diagnosed with ureterocele and voiding cystourethrography (VCUG) were evaluated. A total of 24 (female 13 (54.2%)) children were included. The reasons for admission were antenatal hydronephrosis in 13 (54.2%) patients, UTI in 9 (37.5%) patients, and incidentally diagnosed ureterocele in 2 (8.3%) patients. Urinary tract infection was observed in 20 patients at admission, recurrent UTI in 21 patients at follow-up, preoperative pyelonephritis in 12 patients. VUR was found in 11 patients, and severe VUR (≥stage 3) was found in 9 patients. Ten patients had ipsilateral hydronephrosis, and 14 patients had a double collecting system. The presence of VUR was found to be associated with female gender, UTI at admission, and recurrent UTI at follow-up (p < 0.05). However, there was no difference between groups with or without VUR in terms of ipsilateral hydronephrosis, scar formation, and the need for surgery (p > 0.05). Conclusions: We could not demonstrate any criteria to select patients to receive VCUG; on the other hand, VUR did not cause more kidney damage. Our study supports the need for more scientific data to determine management in patients with ureterocele. [ABSTRACT FROM AUTHOR]

Purpose To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. Methods Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for ‘jet/turbulent’ occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. Results Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24–36 months. Median bladder capacity did not rise significantly in control group. Conclusion Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis.

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Objectives: Ectopic ureter and ureterocele need an adequate treatment plan and different surgical interventions. However, some cases appear as intravesical cystic lesions on ultrasound, with ectopic ureter sometimes reported as pseudoureterocele. This study aimed to describe the sonographic imaging findings of intravesical cystic lesions to differentiate between pseudoureterocele and ureterocele., Methods: Nineteen patients with duplex collecting system and intravesical cystic lesions that were classified into pseudoureterocele and ureterocele based on the surgical findings were included. The ultrasound findings compared between the 2 groups were as follows: intravesical lesion with/without a covered muscular layer, presence/absence of notch sign within the lesion, and dynamic change in the appearance of intravesical cystic lesions using Fisher's exact test., Results: The lesions in 3 patients were classified as pseudoureterocele due to ectopic ureter and the remaining 16 as ureterocele. Significant differences were observed in intravesical lesions with/without a muscular layer (pseudoureterocele versus ureterocele = 3/0 versus 3/13, P = .021) and the presence or absence of a notch sign within the vesical cystic lesion (pseudoureterocele versus ureterocele = 3/0 versus 3/13, P = .021) between the groups. Although there was a tendency for the dynamic change in the appearance of intravesical cystic lesions to be more detectable in cases with ureterocele than in pseudoureterocele, the difference was not significant (0/3 versus 11/5, P = .058)., Conclusions: Sonographic findings, including bladder muscular layer location and the presence of a notch sign within the cystic lesion, were useful in differentiating pseudoureterocele and ureterocele in intravesical cystic lesions in pediatric patients with a duplex collecting system., (© 2024 American Institute of Ultrasound in Medicine.)

Background: The ectopic ureter is any single or duplex ureter that enters beyond the anatomical area of the triangle of the urinary bladder. Abnormal ureter opening is one of the rare defects resulting from abnormalities in fetal development. The present study focuses on an up-to-date narrative review of the clinical and anatomical aspects of the ectopic ureter and coexisting urinary tract abnormalities. Materials and methods: This review includes an analysis of the literature on the ectopic ureter and coexisting urinary tract anomalies. A query was conducted in electronic databases (PubMed, Web of Science, and ScienceDirect) to investigate the abovementioned topic. The literature search was based on the following criteria and keywords: ectopic ureter, duplication of the ureter, and ureterocele. The date and language of publication were not the exclusion criteria. Conclusion and outcome of the review: The ectopic ureter is one of the anomalies among congenital abnormalities of the kidney and urinary tract. In about four out of five cases, it coexists with other defects of the upper urinary tract, such as ureter duplication and ureterocele. Urinary incontinence is the main symptom of ectopic ureter among women due to the most common location of the ureter orifice below the bladder sphincter. It may be asymptomatic or mildly symptomatic in men and cause recurrent epididymitis or urinary tract infections. Treatment of this disease consists of constant observation by regular control visits, and when the abnormality becomes symptomatic, a surgical procedure should be performed. It should be underlined that after finding an anatomical defect of the urinary system, clinicians should consider whether it causes disturbing symptoms and whether its corrective maintenance operation will be beneficial to the patient.

A 36-year-old man consulted a urology clinic with the complaints of intermittent stream, dysuria, feeling of residual urine, and frequent urination. Ultrasonography revealed a cystic mass on the right side of the bladder neck and dilation of the right upper tract, and the patient was referred to our hospital. Cystoscopy revealed bilateral ureteroceles. Contrast-enhanced CT showed bilateral upper urinary tract dilation. Transurethral incision of the bilateral ureteroceles was performed. The symptom of dysuria disappeared after the surgery, and vesicoureteral reflux (VUR) was not observed. Ureterocele is a defect mainly found in children, and ureteroceles found in adult men are relatively rare. We discuss this case of ureterocele in an adult male and offer a review of the literature. [ABSTRACT FROM AUTHOR]

Ureterocele is a distal ureteral segment cystic dilatation. Its prevalence in women ranges from 1/5000 to 1/12000.A 22-year-old adult female presented with a vulvar tumor with left-side pain. She was a candidate for an interlabial lump biopsy. A vulvar growth mimicking a uterine polyp was identified during her further evaluation. On ultrasonography of the abdomen and pelvis, a left-sided hydronephrisis (grade 1), proximal ureteral dilatation, and a ureterocele related to the distal portion of the left ureter that protruded into the urethra were detected. Under anesthesia examination, the ureterocele was removed.

To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for 'jet/turbulent' occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24–36 months. Median bladder capacity did not rise significantly in control group. Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis. [ABSTRACT FROM AUTHOR]

Abstract Background Association of the ureterocele and proximal ureteral valve is a rare congenital anomaly which can lead to quick detoriation of renal function due to double obstruction. Though ureteral valves have been associated with other ureteral anomalies, this specific association is extremely rare. Case presentation A 7-month-old boy was referred to us for antenatally detected hydronephrosis. Provisional diagnosis of orthotopic ureterocele with pelviureteric junction (PUJ) obstruction was made based on preoperative imaging. Endoscopic incision of ureterocele was done and retrograde pyelography showed tight obstruction at PUJ which necessitated a pyeloplasty. Examination of resected specimen confirmed a ureteral valve. Postoperatively, the patient had good improvement in kidney function. Conclusion To conclude, congenital ureteral valves are a rare cause of ureteric obstruction and its association with ureterocele is rarer still. Identification of an ureterocele should not deter us from searching for an associated pathology like a ureteric valve when imaging shows more severe hydronephrosis suggestive of more proximal obstruction.