Diagnosi prenatale e sezione endoscopica precoce dell'ureterocele.

The endoscopic incision of ureterocele in children is still a controversial procedure. In two Departments of Pediatric Surgery, between January 1990 and December 1994, 47 patients (34 females, 13 males), for a total of 53 ureteroceles, underwent endoscopic incision of the ureterocele as the primary form of treatment; 41 ureteroceles were in duplex kidney. In 33 cases (70%) the prenatal ultrasound had observed hydronephrosis or duplex kidney or the presence of the ureterocele; these babies were free of urinary infection before treatment. 45 of the 47 babies were less than 6 months old at the time of the endoscopic incision. Vesico-ureteral reflux developed in none of the single systems, and in 32% of the duplex systems; however a preexisting reflux spontaneously disappeared in 41%. At 1 year follow-up the mean increase in renal parenchyma as evaluated at ultrasound was from 6.4 to 11.1 mm in single systems, and from 3.4 to 6.3 mm in duplex kidneys. Scintigraphy or urography showed a stable or improved renal function in all previously functioning units; 40% of the non-functioning units before section showed signs of function at 1 year follow-up. One to 3 years after section, 14 children underwent open surgery for persisting vesico-ureteral reflux, urinary infections or non-functioning unit: 9 ureteroneocystostomies and 5 heminephrectomies were performed. The endoscopic incision is proposed as the early first treatment of ureteroceles, mainly in cases of prenatal diagnosis, possibly performed in the neonatal age. In the Authors' experience it has been effective in preventing sepsis in all patients and in preserving the renal function of the involved unit; surgery has been avoided in over 60% of cases and when necessary it has been safely postponed after more than 1 year of age.