Duplex ureteroceles: is radical surgery always necessary?

To answer the question about the best therapeutic procedure in duplex ureteroceles a prospective and retrospective study was performed. In a first group we summarized the patients operated from 1971 to 1986. These infants and children were compared to a group operated from 1987 to 1992. In the first group the operative procedure was chosen according to the presence or absence of reflux into the lower pole system. All patients with reflux were corrected radically in one operation. The control showed a reoperation rate of 45% (8 of 18 patients). 3 patients lost a functioning renal unit. In the second group the operative procedure was chosen according to the function of the upper pole. It was resected if its function was below 10% measured by DMSA-scintigraphy. In cases with functioning upper pole a pyeloureterostomy was performed. Only in two cases the ureterocele was resected primarily. In this group a second operation was necessary in only 3 of 16 patients and renal function was preserved in all cases. Our results show that radical surgery in duplex ureteroceles is seldom necessary and a staged procedure is the method of choice.