Factors of transurethral incision effectiveness for ureteroceles in pediatric patients: A 28-year, single-institution retrospective review

Background As a congenital anomaly, ureteroceles occur in 1 in 4000 children, and are usually diagnosed prenatally. However, there remains a lack of definite consensus on the optimal management of congenital ureteroceles. Objective We evaluated factors associated with success of primary transurethral incision (TUI) in ureterocele pediatric patients. Methods Demographic and clinical information for 120 pediatric patients who were diagnosed with congenital ureterocele between 1993 and 2021 at our institution were obtained through retrospective chart review. Data were analyzed using Fisher's exact tests, t-tests, and logistic regression with a significance threshold of p < 0.05. The primary outcome of ureterocele management was TUI effectiveness, defined by no need for further surgical intervention. Results Of the 120 patients (39 boys, 81 girls) with ureteroceles, 75 patients (22 boys, 53 girls) met our inclusion criteria of undergoing initial TUI ureterocele. Initial TUI was effective in 51/75 patients (68.0%). We analyzed possible correlative factors for TUI efficacy. Simplex system was a significant predictor of primary TUI efficacy (85% effective in simplex systems, 62% in duplex systems). Prior urinary tract infection, prenatal diagnosis, and electrocautery technique were all associated with an increased risk of needing additional surgeries after primary TUI. Discussion The most significant predictors of effective primary TUI were simplex system and the absence of preoperative vesicoureteral reflux. Prenatal diagnosis, preoperative febrile urinary tract infection, higher preoperative hydronephrosis grade, and the use of electrocautery were all associated with decreased primary TUI efficacy. Study limitations include that it was a retrospective chart review, and cohort size was limited by incomplete urology follow-up and operative records. Conclusions Summary TableAssociation of key patient factors with TUI efficacy. Factor TUI Effective (%) TUI Noneffective (%) Odds Ratio 95% Confidence Interval P-value Ureter Anatomy Simplex System 17/20 (85.0%) 3/20 (15.0%) 3.45 1.01-Inf 0.048∗ Duplex System 34/55 (61.8%) 21/55 (38.2%) Febrile Urinary Tract Infection Before TUI a Of the 21 patients who experienced a preoperative febrile UTI, 14 also experienced a febrile postoperative UTI. Prior UTI 11/21 (52.4%) 10/21 (47.6%) 0.39 0.00–1.07 0.064 No Prior UTI 40/54 (74.1%) 14/54 (25.9%) Preoperative Reflux Preop Reflux 15/28 (53.6%) 13/28 (46.4%) 0.36 0.11–1.09 0.045∗ No Preop Reflux 36/47 (76.6%) 11/47 (23.4%) Surgical Technique: Electrocautery(n = 74) Electrocautery Used 18/32 (56.25%) 14/32 (43.75%) 0.41 0.00–1.04 0.059 Electrocautery Not Used 32/42 (76.2%) 10/42 (23.8%) ∗p < 0.05. a Of the 21 patients who experienced a preoperative febrile UTI, 14 also experienced a febrile postoperative UTI. Open table in a new tab