EN
TÜRKÇE
Case Report - 4
Pneumovesicoscopic Ureterocele Excision and Ureteroneocystostomy in a Single-System Ureter
Beytullah Yağız, Pelin Nur Cinel, Sertaç Hancıoğlu, Berat Dilek Demirel
Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Surgery, Samsun, Turkey
Surgical indications for ureterocele management may include ureteral or bladder outlet obstruction, deterioration of renal function, and presence of symptoms. Since de novo reflux may occur after ureterocele excision, ureteroneocystostomy is necessary. Furthermore, removal of large ureteroceles can result in a significant detrusor defect at the bladder base, which may complicate the repair process.
A 5-year-old female with documented ureterocele in the right kidney was re-evaluated due to new onset symptoms of bladder dysfunction. Ultrasonography revealed 12 mm pelvic diameter in the right kidney and the right ureter diameter measured 8 mm. A 16x16 mm ureterocele was observed within the bladder. Lumbosacral MRI was requested, and no evident spinal anomaly was detected. A DMSA scan revealed scarring in the right kidney with a differential function of 21% and surgery was recommended.
Cystoscopy revealed an obstructive ureterocele on the right side. The bladder was suspended at three points, and ports were introduced; 5 mm from the apex and 3 mm from each lateral side. The right ureterocele was excised using a hook cautery, exposing the ureteral orifice. The ureter was dissected using the hook cautery, including the mucosa at the base of the ureterocele. A new hiatus was created proximally, and the ureter was re-introduced into the bladder through this opening. The old hiatus was closed, and a submucosal tunnel was created. The distal ureter was excised, and a ureteroneocystostomy was performed. A double-J stent was placed, concluding the procedure.
In suitable cases, pneumovesicoscopic ureterocele excision and ureteroneocystostomy allow for a minimally invasive repair with precise dissection under superior visualization. However, due to the narrow working space and difficulty of manipulation, the learning curve is slow and requires experience