Clinical Features and Management in Patients with Prenatally Detected Duplex System Ureteroceles

Oh, Seung June; Lee, Ahnkie; Lee, Seung Bae; Choi, Hwang

Abstract

PURPOSE: Prenatal sonography resulted in increased recognition of renal duplication anomalies and, therefore, earlier urological referral and evaluation. However, surgical approach in very young children is debating. We attempt to investigate clinical features and to propose the management strategies in patients with prenatally detected ureteroceles. MATERIALS AND METHODS: From 1982 to 1997, there has been 35 patients (47 units) of duplex system ureter in which both preoperative and postoperative imaging studies including DMSA renal scan were available. Among these, detailed diagnosis and treatment of prenatally detected (PreD) ureteroceles associated with duplex system (9 patients or 12 ureteroceles) were assessed compared with post-natally detected (PND) ones (26 patients or 35 ureteroceles). RESULTS: There were 2 males and 7 female patients in PreD group, whose ureteroceles presented as 6 unilateral (right 1, left 5) and 3 bilateral units. There were 3 patients (33%) presented with urinary tract infection in PreD group and 24 patients (92%) in PND group. Functional evaluation by DMSA renal scan revealed that 8 units (67%) were functioning in PreD group while 37% in PND group, which was not significantly different between two groups. Initial treatment in PreD group were performed in 11 units; transurethral ureterocele incision (TUI, 8 units), ureteroureterostomy (UUO, 1) and upper pole nephrectomy (UPNx, 2). Additional surgery was performed in 8 units, all of which were initially performed TUI. When initial functional status of the upper pole (UP) determined by renal scan were analyzed by ultimate mode of treatment, initially nonfunctioning parenchyme resulted in UPNx in 4 units and 8 functioning moiety were led to parenchyme-sparing surgery, implying TUI actually had not modified ultimate clinical course. Taken both PreD and PND together, UUO and ureteral reimplantation showed lower secondary operation rate. CONCLUSIONS: Although statistics did not fully support our clinical impression, patients with PreD ureterocele have higher proportion in preserving UP function compared with that of a PND. Our results shows direct approach to the upper pole according to the functional status is preferred.