Surgical management of infantile (ectopic) ureteroceles: report of a modified approach.

Since 1970, our experience in managing 22 patients (24 renal units) with infantile (ectopic) ureteroceles suggests that no single procedure is universally applicable. Certain general principles, however, guide management strategy. First, preservation of the upper pole moiety is successful if there is functioning renal parenchyma on IVP (9 cases with one failure). Second, when extirpation is required, total ureterectomy-ureterocelectomy is unnecessary (13 cases with no reoperations specifically for stump extirpation). Third, urinary tract infections are fairly common in the first postoperative year (4 of 16 patients), being more common in children with common sheath ("double barrel") reimplantations. This review of our experience often showed the primary procedure to be long and difficult with significant blood loss. Although it did not occur in this series, devascularization of the lower pole ureter remains a danger. Therefore, a two-stage procedure was developed to obviate these problems. In the last 4 patients (5 renal units) in this series, the ureteroceles were first incised endoscopically. Six weeks later, reimplantation or upper pole nephrectomy-partial ureterectomy was performed. Adequate early decompression of the ureterocele resulted in less operative time and blood loss (average 27.5 cc for upper pole nephrectomy) at the subsequent procedure. We now prefer this method, especially in very young or compromised patients, although the follow-up time is inadequate to recommend it generally.