Investig Clin Urol.  2019 Jul;60(4):295-302. 10.4111/icu.2019.60.4.295.

Impact of de novo vesicoureteral reflux on transurethral surgery outcomes in pediatric patients with ureteroceles

• Song SH
• Lee DH
• Kim H
• Lee J
• Lee S
• Ahn D
• Park S
• Kim KS

• KMID: 2450547
• DOI: http://doi.org/10.4111/icu.2019.60.4.295

Abstract

PURPOSE
We aimed to determine the impact of de novo vesicoureteral reflux (VUR) on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles.
MATERIALS AND METHODS
We retrospectively reviewed the medical records of 34 patients (36 renal units) with ureteroceles that were treated endoscopically. Perioperative radiologic and clinical data regarding de novo VUR, UTI, and renal function were analyzed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, and deterioration of renal function.
RESULTS
Of the 36 renal units, 22 had a duplex system (61.1%). Preoperative VUR was noted in 9 units (25.0%), including 3 units without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 28 units (77.8%). De novo VUR developed in 18 renal units (50.0%) postoperatively. The absence or presence of de novo VUR was not related to unfavorable surgical outcomes in univariate or multivariate analyses. Even after selection for the 28 renal units without preoperative VUR, the occurrence of de novo VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 14 renal units without renal duplication, de novo VUR had no predictive value for any of these adverse outcomes.
CONCLUSIONS
After endoscopic ureterocele puncture, de novo VUR is not significantly associated with postoperative UTI or deterioration in renal function in the long term. It may not, therefore, be necessary to reconstruct lower urinary tract routinely to correct de novo VUR after endoscopic puncture of the ureterocele.

Keyword

Endoscopy; Punctures; Ureterocele; Urinary tract infections; Vesico-ureteral reflux

MeSH Terms

Endoscopy
Humans
Hydronephrosis
Logistic Models
Medical Records
Multivariate Analysis
Punctures
Retrospective Studies
Ureterocele*
Urinary Tract
Urinary Tract Infections
Vesico-Ureteral Reflux*

Figure

• 

  Fig. 1 Schematic images of the endoscopic ureterocele puncture technique. (A) A large, single puncture was made with a 5 Fr Bugbee electrode at the intravesical, inferomedial portion of the ureterocele just above the bladder neck. (B) Small, multiple punctures were made at two or more sites using a 2 Fr Bugbee electrode at the inferomedial portion of the ureterocele until the ureterocele decompressed securely.

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