Goals of treatment include the following:
- Control of infection
- Preservation of renal function
- Protection of ipsilateral and contralateral renal units
- Maintenance of urinary continence
- Elimination of obstruction and reflux
Surgical therapy for both pediatric and adult ureteroceles may include endoscopic puncture, incision or transurethral unroofing of the ureterocele, upper pole heminephrectomy, excision of ureterocele and ureteral reimplantation, and nephroureterectomy.
Endoscopic puncture is the least invasive method for ureterocele decompression. This is an ideal method for dealing with a neonate with ureterocele-induced obstructive uropathy and sepsis. It may also be performed safely in adults with a symptomatic ureterocele. Other indications include a single system intravesicalureterocele with obstruction or a duplex system ureterocele with indeterminate function of the affected renal moiety. Performed via the cystoscope, a small puncture is created at the base of the ureterocele. This technique is often done using a 3F Bugbee electrode. The thermal damage to the surrounding tissue subsequently results in an opening larger than 3F. With a thick-walled ureterocele, either a larger puncture or incision, or multiple punctures may be required to establish drainage. Multiple endoscopic procedures may be required to successfully decompress an ectopic ureterocele.
Transurethral unroofing of a ureterocele in adults reliably achieves decompression and allows effective treatment of infection and calculi in symptomatic ureteroceles. Low transverse incision of the ureterocele, as described by Monfort and colleagues creates a “flap-valve” effect and minimizes the chance of subsequent vesicoureteral reflux compared with transurethral resection of the ureterocele roof.