[Ureterocele in adults based on a series of 14 cases].
キーワード
概要
OBJECTIVE
To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults and to determine the incidence of its main complication, vesico-ureteric reflux.
METHODS
Retrospective study of 14 cases of ureterocele in adults observed between March 1989 and August 2004, corresponding to 7 males and 7 females with a mean age of 39 years (range: 17-73 years). The ureterocele was observed in a context of single ureter in 13 cases (94%) and duplicated ureter arising from the superior renal unit in one patient (7%). The ureterocele was complicated by stones in 9 cases (64%). Endoscopic meatotomy was performed in 13 patients, while immediate resection of the ureterocele followed by Hendren ureterovesical reimplantation was performed in one patient with major proximal repercussions.
RESULTS
The postoperative course was uneventful in all patients including the patient treated by conventional surgery. Postoperative follow-up consisted of clinical and radiological assessment at 3 months and 6 months. Endoscopic treatment was effective in every case with resolution of low back pain and absence of residual stones when the ureterocele was initially complicated by stones. In contrast, de novo vesicoureteric reflux appeared secondarily in 5 patients (38.5%) but persisted at 6 months in only one patient, who required re-operation: resection of the ureterocele and Hendren ureteric reimplantation.
CONCLUSIONS
Endoscopic meatotomy can be considered to be the firstline treatment for ureterocele in adults in the absence of severe dilatation of the proximal urinary tract. Its main complication remains vesico-ureteric reflux. Radiological surveillance by urethrocystography therefore appears to be essential.
