Transurethral Endoscopic De-roofing of Adult Single System Orthotopic Ureteroceles

Background: Ureteroceles are cystic dilatations of the distal ureter that occur due to congenital ureteric wall weakness. Only 20% are termed single-system orthotopic ureteroceles and occur in normal ureteric locations typically known as “adult ureteroceles”. It is a rare condition with incidence ranging from 1:500 to 1:4000 affecting more females than males in a ratio of 6:1. There is no consensus in literature regarding the best endoscopic technique in treating ureteroceles in adults. The purpose of the study is to retrospectively evaluate the safety and effectiveness of endoscopic de-roofing in adults with single system ureteroceles. Here we describe our experience with endoscopic de-roofing using the transurethral cutting loop.

Methodology: This is a 6 year retrospective cross-sectional study of 11 patients aged18 years and above with 13 orthotopic adult ureteroceles who underwent endoscopic de-roofing. The inclusion criteria were all consenting adult patients who had endoscopic de-roofing for symptomatic ureteroceles. The duration of follow up to assess the outcome of the procedure ranged from 3 to 9 months. Their data were retrieved from case notes for analysis.

Results: This series consisted of nine women and 2 men (F: M 4.5:1) with a mean age of 36.5 +/-14.8 years (range 21 - 57). The dominant presenting complaint was flank pain which was observed in all but two patients (n = 9, 81%). Others symptoms included hematuria (n = 4, 36%) and those of urinary tract infection (n=8, 73%). A total of 11 patients and 13 orthotopic ureteroceles were operated upon as elective cases 10 (91%), while 1 (9%) case, with bilateral obstruction from stones, was operated upon as an emergency. The patients were all discharged home after an over-night stay in hospital following the procedure except the case with bilateral renal obstruction. There was clinical resolution of symptoms in our patients and no major surgical complication was recorded.

Conclusion: The endoscopic approach to treating adult single-system orthotopic ureteroceles using transurethral resection cutting loop at low current is an effective, safe and easily adaptable procedure.