Minimally-invasive treatment of complicated ureteroceles in adults avoiding vesico-ureteric reflux

Introduction. Ureteroceles are not rare findings in adults. In contrast to pediatric ureteroceles, the therapy modalities in adults are different and recommendations are scarce. patients and methods. Nine complicated ureteroceles in eight adults were treated minimally invasive by endoscopic incision or puncture. All ureteroceles were located orthotopically. One patient had a bladder outlet obstruction due to a sliding ureterocele. In four patients urolithiasis was found within the ureterocele, bilaterally in one of these. All operative interventions were done endoscopically. In five patients with calculi, a low transversal incision, i.e. unroofing of the ureterocele, allowed for stone extraction preserving the flap valve func-tion. In the patient with bladder outlet obstruction a single puncture using a bug bee electrode led to decompression of the ureterocele. results. The follow-up was done by ultrasound and urine examinations as well as voiding cystography. In no patients was there post-void residual urine or infections postoperatively. The mean follow up time was 21.3 months (4 to 48 mos.). All patients were endoscopically and sonographically free of stones and voiding discomfort was resolved. There were no cases of postoperative vesicoureteral reflux or secondary surgery. Conclusions. Uncomplicated ureteroceles usually do not require treatment; in symptomatic ureteroceles, requiring individual surgical intervention, an endoscopic approach is feasible and easy to perform according to the clinical and anatomical findings. In case of obstructive voiding problems in young adults, a sliding ureterocele into the bladder neck should be considered.