Single system ureterocele in children: analysis of a cohort study of an infrequent (no-so-benign) condition

Abstract

Romina Ammann, Tarek Khamis Juri, Javier Ruiz, Sebastian Tobia, German Quevedo, Diane Decaluwe, José María Angulo, Catalina Tessi, Marco Perez-Brayfield, Massimo Catti, Simona Nappo, José Antonio Sepúlveda, José Luis Fadil, Fernando González, Juan Pablo Corbetta, Nicolás Rosiere, Edurne Ormaechea, Abelardo Yepes, Paz Bustamante, Jorge García, Bernardita Troncoso, Imran Mushthaq, Juan Manuel Moldes, Marie-Klaire Farru- gia, George S Bethell, Francisco Reed, Francisca Yankovic and Pedro-José López*

Single System Ureterocele (SSU) in pediatrics is rare, with very few publications. There is the impression that it should only be observed and therefore, its treatment could be different from the classic double- system ureterocele. The aim of this study is to analyze the characteristics of pediatric patients with SSU and its treatment. An observational, analytical, multicenter retrospective cohort study that included patients diagnosed with SSU between 2005-2022 in 19 centers from different countries. Demographic, diagnostic and treatment data were collected. The inclusion criteria were diagnosis of SSU and follow-up at least 6 months with renal ultrasound. There were 69 cases of SSU in an 18 years’ period; 58/69 (84%) were unilateral (27 right, 31 left). The diagnosis was antenatal in 21/69 (30%), Urinary Tract Infection (UTI) in 27/69 (39%) and lumbar pain in 6/69 (9%). As initial treatment, 53/69 (77%) underwent endoscopic surgery; 49 puncture and 4 balloon dilations; different procedures were performed in 7/69 (10%) (4 reimplantations, 3 nephrectomies) and 9/69 (13%) were observed clinically. Of the 49 punctured, 12/49 (24%) required another procedure; 10/12 had one extra procedure and 2/12 more than 3 procedures. At ultrasound >6 months, 39/66 (59%) showed ureterocele collapse in addition to resolution of Hydro Uretero Nephrosis (HUN). This series shows that SSU might not be as “benign” as previously thought, since 48% presented with symptoms. The majority of patients 53/69 (77%) underwent endoscopic treatment with an additional 24% who required more than one procedure. In our series, only 13% (9/69) were managed conservatively with good evolution upon follow up.