A novel approach for an old debate in management of ureterocele: long-term outcomes of double-puncture technique.

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. In this study, long-term outcomes of double-puncture technique are evaluated. 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. 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. Double-puncture technique is a successful endoscopic intervention for immediate and durable decompression of ectopic ureteroceles without incurring major complications. 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). Summary Figure [ABSTRACT FROM AUTHOR]