[Endoscopic resection of an orthotopic ureterocele, an alternative to open surgery].

Abstract

The paper reports on the results of the endoscopic treatment in 16 cases of orthotopic ureterocele, out of which 11 developed on a simplex ureter and 5 on the superior ureter of the pyeloureteral duplicity (ren duplex). In 6 patients the pseudocystic dilatation of the submucous ureter contained calculi. The endoscopic treatment consisted of: the ureterocele resection in 12 patients (in 6 of them it was associated with the extraction of the calculi with Lowsley's lithotryptic clip): the ureterocele incision in 3 cases; and the endoscopic resection of the intravesical sac, with nephrouretectomy of the dysfunctional pelvis and the respective ureter in one case. The results recorded showed urographic improvement in 14 patients and uroculture sterilization in 11 cases of 14 with postsurgical urinary infections. Only in one case, the ureterohydronephrosis advanced, requiring the subsequent ureter-bladder reimplantation. No case of bladder-ureter reflux following the endoscopic resection or incision of the orthotopic ureterocele was recorded. Endoscopic resection or incision is a simple and efficient method for treating small or middle orthotopic ureteroceles, if the superior urinary system is recoverable. The method is simple and with low risks, and it can be applied as first therapeutic time in all the cases, even in those in which the chance of the definitive solution is less probable, as in the secondary surgical time the classical surgical correction of the uretero-bladder junction can be used.