Hans G Pohl1. 1. Children's National Medical Center, George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia 20010, USA. hpohl@cnmc.org
Abstract
PURPOSE OF REVIEW: Ureteroceles are an infrequently seen and challenging pediatric urological condition that in addition to causing obstruction, may also be associated with vesicoureteral reflux and/or obstruction of the bladder outlet. Past experience with the morbidity associated with ureteroceles presenting with urinary tract infection may have stimulated a particularly aggressive approach as evidenced by more historical reports describing total reconstruction. This article purposes to review the recent literature in support of less aggressive management of ureteroceles in children. RECENT FINDINGS: The widespread availability and reported high success rates with endoscopic puncture of ureteroceles, along with the recognition that vesicoureteral reflux associated with ureteroceles can be effectively managed nonoperatively, has shifted the paradigm towards an individualized approach with greater emphasis placed on nonoperative management or less aggressive surgical techniques. Cystic renal dysplasia associated with ureterocele, much like that seen in isolation, is likely to involute thus providing spontaneous 'decompression' of the ureterocele and avoiding the need for surgery when it is present. SUMMARY: Although total reconstruction of renal moieties associated with ureteroceles might be appealing as it can achieve a normal appearing urinary tract with a single procedure performed in infancy, a more individualized approach that relies on less aggressive surgical treatments and nonoperative management over time can achieve the same functional results.
PURPOSE OF REVIEW: Ureteroceles are an infrequently seen and challenging pediatric urological condition that in addition to causing obstruction, may also be associated with vesicoureteral reflux and/or obstruction of the bladder outlet. Past experience with the morbidity associated with ureteroceles presenting with urinary tract infection may have stimulated a particularly aggressive approach as evidenced by more historical reports describing total reconstruction. This article purposes to review the recent literature in support of less aggressive management of ureteroceles in children. RECENT FINDINGS: The widespread availability and reported high success rates with endoscopic puncture of ureteroceles, along with the recognition that vesicoureteral reflux associated with ureteroceles can be effectively managed nonoperatively, has shifted the paradigm towards an individualized approach with greater emphasis placed on nonoperative management or less aggressive surgical techniques. Cystic renal dysplasia associated with ureterocele, much like that seen in isolation, is likely to involute thus providing spontaneous 'decompression' of the ureterocele and avoiding the need for surgery when it is present. SUMMARY: Although total reconstruction of renal moieties associated with ureteroceles might be appealing as it can achieve a normal appearing urinary tract with a single procedure performed in infancy, a more individualized approach that relies on less aggressive surgical treatments and nonoperative management over time can achieve the same functional results.