A 20-YEAR EXPERIENCE WITH TREATMENT OF ECTOPIC URETEROCELES

Between 1970 and 1990 a total of 37 patients (female-to-male ratio 3.6:1) was diagnosed and treated at our institution for ectopic ureterocele. Urinary tract infection was the most frequent mode of presentation (59%). Of the patients 54% were less than 3 years old at operation. Transurethral incision of ectopic ureterocele served only as a decompressive procedure for acutely ill infants and was followed with a high incidence (80%) of resultant vesicoureteral reflux. The elective surgical policy was individualized based on renal function and presence of vesicoureteral reflux. Overall results within the various groups were generally satisfactory regarding eradication of urinary tract infections, preservation of renal function and continence or treatment of vesicoureteral reflux. Upper pole heminephrectomy and partial ureterectomy were performed in 14 patients with 3 (21%) requiring reoperation, including only 2 (14%) subsequent reimplantations. Thus, we believe that an expectant approach to the lower urinary tract is well recommended in the majority of the patients with a poorly functioning ipsilateral renal segment. A modified technique of total reconstruction, performing only partial ureterectomy with double barrel reimplantation, was successful in 7 patients.