Kajbafzadeh A et al. (2007) Evolution of endoscopic management of ectopic ureterocele: a new approach. J Urol 177: 1118–1123

Endoscopic decompression is preferred to open surgery as first-line therapy for children with ectopic ureterocele in some centers because the endoscopic procedure is easier to perform and is associated with minimal morbidity. Reliable data that compare the success of different endoscopic treatments for ectopic ureterocele are, however, lacking. Kajbafzadeh and colleagues have reviewed data from 46 children treated at their center; during a 10 year period (1995–2005) their standard endoscopic treatment evolved from ureterocele incision (unroofing) to double puncture, followed by insertion of a Double-J® (Cabot Technology Corporation, Santa Barbara, CA) stent and intraureterocele fulguration. Their current procedure also includes endoscopic subureteral injection of tricalcium phosphate ceramic to mimimize postoperative vesicoureteral reflux (VUR).

All 46 children (mean age 2.3 years, 17 male) had duplex collecting systems and ectopic ureteroceles. Follow-up ranged from 1 to 9 years. Treatment was completely successful in 0%, 25% and 33% of the patients treated with ureterocele incision (n = 4), single ureterocele puncture (n = 4), or single puncture with insertion of Double-J® stent (n = 9), respectively. Ureterocele double-puncture and intraureterocele fulguration (n = 29) was completely successful in 90% of patients. Of the 17 who underwent common endoscopic treatments, 6 patients developed new-onset VUR in the ureterocele moiety; in the double puncture group (n = 29) no patient developed VUR in the ureterocele moiety.

The authors suggest that the intraureterocele fulguration used in their double-puncture procedure encourages layer adhesion and creates muscular support that prevents postoperative VUR.