Techniques to reduce the risk of reflux
To prevent reflux of urine from the bladder into the ureter after opening the ureterocele, the incision is made minimal (3–5 mm) in the lower part of the ureterocele, closer to the neck of the bladder, using a laser or hook-shaped electrode; the upper wall of the ureterocele collapses and covers the opening like a valve. The stones inside the ureterocele are removed in the same operation. After 3 months, ultrasound monitoring and cystography are performed; In case of a double kidney with a nonfunctioning upper half, endoscopic dissection may be the first step before heminefroureterectomy.
Ureterocele and ostial stenosis
Ureterocele is a congenital cystic dilatation of the intravesical ureter due to a narrow orifice; it interferes with the flow of urine, causes hydronephrosis, infections and stones, and a large ureterocele can block the neck of the bladder. Stenosis of the ureteral orifice also occurs after TUR, radiation therapy, tuberculosis, or long-term presence of a stone in the orifice. In both cases, endoscopic dissection restores outflow.
After surgery
The patient spends 1–2 days in the hospital; if a stent is installed, it is removed after 2–4 weeks. The main risk after dissection of a ureterocele is vesicoureteral reflux, so the incision is made minimal and in the lower part, and after 3 months a control cystography is performed. If reflux persists or the upper half of the double kidney is nonfunctioning, ureteral reimplantation or heminefroureterectomy is discussed.
