Guide for families of children with ureterocele
What is a ureterocele?
Ureterocele is the ballooning of the part of the ureters, the tube-shaped structure that transmits urine from the kidney to the bladder, within the bladder. Due to the very small hole where the ureter opens into the bladder and preventing the urine flow, an enlargement occurs in this area and appears like a thin-walled balloon inside the bladder. The size of ureteroceles is variable, some very small while others may be large enough to cover the bladder.
Ureteroceles can be inside the bladder, or they can grow out of the bladder and go out of the urethra. Ureteroceles can also be seen with the double collecting system.
When urinary flow is obstructed in ureterocele or in the presence of vesicoureteral reflux, which is frequently encountered in ureteroceles; urine returns to the ureter. Returning urine may accumulate in the ureter and kidney, causing enlargement of the urinary tract, infection, and loss of kidney tissue.
How is it diagnosed?
With the widespread use of prenatal ultrasound examinations, enlargement of the kidneys is usually observed in babies in the intrauterine period. In this case, ureterocele can be seen if ultrasound is performed within the first week after birth. Urinary tract infection develops if there is evidence of obstruction in the urinary tract or urinary reflux with ureterocele. Ureterocele can also be diagnosed in the examinations performed after urinary tract infection.
What are the surgical requirements?
Severe enlargement of the kidney and ureter due to ureterocele in infants and children, urinary infection, stones, and bladder emptying problems require surgical treatment.
How is a ureterocele treated?
Treatment is not the same for all ureteroceles, some are treated with simpler methods, while others require extensive surgery. Therefore, the treatment is chosen according to the clinical condition of the patient. Factors affecting the treatment option; The treatment option is decided by factors such as the size of the ureterocele, the condition and degree of obstruction in the urinary tract, whether the kidney is functioning, whether there is urine leakage towards the kidney (vesicoureteral reflux), whether the bladder is affected, and the presence of additional urinary tract anomaly (such as double collecting system).
How is the preparation for the surgery done?
If there is urinary infection in patients before surgery, they should be treated. A fasting period of 4-6 hours is required before this procedure, which is performed under general anesthesia in children.
How is surgical treatment done?
- Endoscopic treatment (ureterocele incision): It is the most common procedure in the surgical treatment of ureterocele. During the surgical procedure, a lighted instrument called a cystoscope is entered through the urethra and the inside of the bladder is examined. The bladder is filled and emptied with sterile fluid, and its characteristics such as the size and location of the ureterocele, its relationship with the urethra, bladder outlet, and openings of other ureters are evaluated. At the base of the ureterocele, the area to be incision or puncture is determined. An incision is made in the determined area with a special piercing/cutting tool advanced through the cystoscope. It can be observed that the ureterocele is emptied and extinguished, and the smooth passage of urine into the bladder. The process usually takes 15-20 minutes. There are no visible incisions. As the urine empties into the bladder through this new opening created, the enlargement of the ureter and kidney improves over time. In patients whose ureterocele cannot be adequately drained by incision, the incision procedure can be repeated later.
- Ureteroneocystostomy: It is an open surgery performed under general anesthesia. It is the re-mouthing of the ureter into the bladder. The ureterocele in the bladder is removed with an incision made in the lower abdomen, and the urinary tube, which is the continuation of the ureterocele, is brought back into the bladder. Repairing the bladder floor and bladder neck is important for future urinary retention problems. In children with severe reflux and excessive anatomical problems in the bladder, larger corrective surgeries may be required when they reach the appropriate age.
These operations can also be performed with the laparoscopic and robotic methods by making small incisions in the abdominal wall, but this method is not suitable for every child.
- Removal of the upper pole of the kidney: If the ureterocele is associated with the double collecting system and the associated upper pole kidney is not functioning, the non-functioning kidney and the ureterocele can be removed together.
How is the post-surgical care of the patients?
A probe, which will remain for a short time after the procedure, can be inserted according to the surgeon's preference. In general, if there is no bleeding on the day of the procedure or a few days later, this catheter is removed. There may be spasm and pain in the bladder on the days when the catheter is inserted. Slight bloody urine is common due to the incision made. Oral fluid and food intake can be started 2 to 4 hours after the procedure (depending on the age of the child). Depending on the child's urinary infection, preventive or therapeutic antibiotics can be given.
What are the long-term results?
Incision in a ureterocele of a kidney with a single ureter is 80-90% successful. In children called ectopic and in whom the ureterocele extends beyond the bladder neck into the external urinary tract, the success of the procedure is between 10-40%.