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• W2111931464 abstract "Introduction The surgical management of ureteroceles is extremely variable. Some have hypothesized that if these patients were treated with ‘definitive’ staged surgical intervention, the need for further revision surgery would be eliminated. Objective The present study sought to determine if the rate of revision surgery differed among patients who have undergone different surgical approaches for the ureterocele complex. Study Design A large retrospective chart review was conducted, identifying all patients having undergone ureterocele surgery at a single institution over the past 41 years. The cohort was divided into four groups based on surgical approach: upper tract approach (UTA), lower tract reconstruction (LTR), simultaneous upper and lower tract approach (ULTA), and staged lower tract reconstruction (SLTR). Demographics, the presence of preoperative/postoperative VUR, postoperative morbidity and the need for revision surgery were compared using the Chi- squared test, Fisher’s exact test, Kruskal-Wallis test, Mann-Whitney U test (Bonferroni correction), logistic regression modeling and survival analyses (Kaplan-Meier and Cox proportional Hazards regression with unplanned revision operation as the outcome event). Results TableDemographics, Interventions, and Revisions. Upper/lower tract (ULTA) (N = 23) Lower tract (LTA) (N = 47) Upper tract (UTA) (N = 18) Staged (SLTR) (N = 32) p-value Median age (IQR), months 5 (2.6–25.8) 6.3 (3.8–16.4) 5.6 (1.3–10.3) 3.7 (1.2–8.1) 0.025 Age group 0.733 <6 months 12 (52.2%) 22 (46.8%) 10 (55.6%) 19 (59.4%) ≥6 months 11 (47.8%) 25 (53.2%) 8 (44.4%) 13 (40.6%) Female 18 (78.3%) 39 (83%) 13 (72.2%) 30 (93.8%) 0.210 Side 0.235 Left 14 (60.9%) 26 (55.3%) 8 (44.4%) 12 (37.5%) Right 9 (39.1%) 20 (42.6%) 10 (55.6%) 17 (53.1%) Bilateral 0 1 (2.1%) 0 3 (9.4%) Lower tract surgery None 0 0 18 (100%) 0 Marsupialization 17 (73.9%) 35 (77.8%) 0 1 (3.1%) Ureterectomy 4 (17.4%) 8 (17.8%) 0 0 TUI/Incision 1 (4.3%) 1 (2.2%) 0 28 (87.5%) Other 1 (4.3%) 1 (2.2%) 0 3 (9.4%) Upper tract surgery None 0 47 (100%) 0 32 (100%) Heminephrectomy 23 (100%) 0 18 (100%) 0 Revision required 4 (17.4%) 10 (21.3%) 9 (50%) 3 (9.4%) 0.009 1 Revision 2 (8.7%) 7 (14.9%) 8 (44.4%) 2 (6.3%) 2 or greater revisions 2 (8.7%) 3 (6.4%) 1 (5.6%) 1 (3.1%) Open table in a new tab Discussion There is a large body of literature examining the surgical management of ureteroceles. It most recently primarily focuses on an endoscopic approach to the lower tract. The present retrospective review examined the need for re-operative intervention by comparing four different surgical approaches, and found that there is no panacea. Although heminephrectomy (UTA) was a definitive procedure in some patients without reflux at presentation, many who underwent heminephrectomy, went on to require later bladder surgery for either recurrent UTI or persistent reflux. The present study has multiple limitations. Although VUR was an indication for revision surgery in the early part of the series, the current treatment of VUR is not necessarily as stringent. In addition, no distinction was made between an orthotopic or ectopic ureterocele, although some authors have reported differing outcomes in these two groups. However, it is felt that given the large data set of a relatively uncommon condition, the lack of superiority of one approach is apparent. Conclusion There is no definitive surgical repair for the ureterocele complex. All groups except UTA had statistically similar rates of revision surgery. The widespread variability in current management echoes the lack of one superior approach found in this comprehensive series. The surgical management of ureteroceles is extremely variable. Some have hypothesized that if these patients were treated with ‘definitive’ staged surgical intervention, the need for further revision surgery would be eliminated. The present study sought to determine if the rate of revision surgery differed among patients who have undergone different surgical approaches for the ureterocele complex. A large retrospective chart review was conducted, identifying all patients having undergone ureterocele surgery at a single institution over the past 41 years. The cohort was divided into four groups based on surgical approach: upper tract approach (UTA), lower tract reconstruction (LTR), simultaneous upper and lower tract approach (ULTA), and staged lower tract reconstruction (SLTR). Demographics, the presence of preoperative/postoperative VUR, postoperative morbidity and the need for revision surgery were compared using the Chi- squared test, Fisher’s exact test, Kruskal-Wallis test, Mann-Whitney U test (Bonferroni correction), logistic regression modeling and survival analyses (Kaplan-Meier and Cox proportional Hazards regression with unplanned revision operation as the outcome event). There is a large body of literature examining the surgical management of ureteroceles. It most recently primarily focuses on an endoscopic approach to the lower tract. The present retrospective review examined the need for re-operative intervention by comparing four different surgical approaches, and found that there is no panacea. Although heminephrectomy (UTA) was a definitive procedure in some patients without reflux at presentation, many who underwent heminephrectomy, went on to require later bladder surgery for either recurrent UTI or persistent reflux. The present study has multiple limitations. Although VUR was an indication for revision surgery in the early part of the series, the current treatment of VUR is not necessarily as stringent. In addition, no distinction was made between an orthotopic or ectopic ureterocele, although some authors have reported differing outcomes in these two groups. However, it is felt that given the large data set of a relatively uncommon condition, the lack of superiority of one approach is apparent. There is no definitive surgical repair for the ureterocele complex. All groups except UTA had statistically similar rates of revision surgery. The widespread variability in current management echoes the lack of one superior approach found in this comprehensive series." @default.
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• W2111931464 title "Examining trends in the treatment of ureterocele yields no definitive solution" @default.
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