Is transurethral incision better than upper pole partial nephrectomy for management of duplex system ureterocoele diagnosed in the first year of life?

Peer review under responsibility of Arab Association of Urology.

Figures & data

Fig. 1 (a) US image shows large lobulated left ureterocoele. (b) Associated left upper moiety Grade 4 hydronephrosis and lower moiety Grade 2 hydronephrosis.

Table 1 Patients’ demographics and characteristics.

Variable		TUI, n/N (%)		PN, n/N (%)
Number of patients		31		13
Gender
Male		8/31 (25.8)		4/13 (30.8)
Female		23/31 (74.2)		9/13 (69.2)
Side
Right		16/31 (51.6)		6/13 (46.2)
Left		15/31 (48.4)		7/13 (53.8)
Laterality
Unilateral		31/31 (100)		13/13 (100)
Bilateral		0/31		0/13
Ureterocoele position^*
Intravesical		11/31 (33.3)		5/11 (44.5)
Extravesical		20/31 (66.7)		6/11 (54.5)
SFU hydronephrosis grading	Pelvicalyceal system	Duplex		Duplex
		Upper moiety	Lower moiety	Upper moiety	Lower moiety
	Grade 0	0/31	11/31 (35.5)	0/13	12/13 (92.4)
	Grade 1	0/31	4/31 (12.9)	0/13	0
	Grade 2	1/31 (3.2)	7/31 (22.6)	0/13	0
	Grade 3	10/31 (32.3)	6/31 (19.4)	2/13 (15.4)	1 (7.6)
	Grade 4	20/31 (64.5)	3/31 (9.6)	11/13 (84.6)	0
VUR^** (Lower pole)	No VUR	11/29 (37.9)		10/13 (76.9)
	Grade1	0/29		0/13
	Grade 2	3/29 (10.3)		1/13 (7.7)
	Grade 3	4/29 (13.8)		2/13 (15.4)
	Grade 4	10/29 (34.5)		0/13
	Grade 5	1/29 (3.5)		0/13
DMSA	Number of patients	24/31		12/13
	Preoperative renal function,%	5.7	34	6.2	32.5

* We were not able to find the ureterocoele position in the surgical reports of 2 patients in the PN group.

** VCUG data were not available for 2 patients of TUI group.

Table 2 Postoperative outcomes after primary intervention.

Variable	Management		P
	TUI	PN
Median age at primary surgical intervention, months	3.5	5.6	0.634
Median postoperative follow up, months	47.4	44.2	0.592
Need for second surgery, n/N (%)	15/31(48.4)	1/13 (7.7)	0.01
Febrile UTI, n/N (%)	13/31 (41.9)	2/13 (15.4)	0.09
Postoperative VUR, n/N (%)	15/24 (62.5)	3/7 (42.9)	0.79
De novo VUR, n/N (%)	5/24 (20.8)	2/7 (28.6)	0.67
Hydronephrosis improvement, n/N (%)	22/31 (71)	12/13 (92.3)	0.123
Renal function improvement, n/N (%)	3/12 (25)	0/9	0.019

Fig. 2 Postoperative VUR according to type of surgical intervention.

Table 3 Types of secondary surgical intervention according the primary approach.

Secondary surgical intervention	TUI, n/N (%)	PN, n/N	P
PN	6/15 (40)	0/1	0.01
PN + LUT reconstruction	2/15 (13.3)	0/1
LUT reconstruction	6/15 (40)	1/1
Renal transplant	1/15 (6.7)	0/1
Total with secondary intervention	15/31 (48)	1/13

Table 4 Comparison between intravesical and extravesical DSUs for the outcomes following TUI and PN.

Complication	Intravesical DSU (n  = 16)	Extravesical DSU (n  = 28)	P
TUI, n/N (%)
Febrile UTI	3/11	10/20 (50)	0.22
Postoperative reflux	3/9	6/15 (50)	0.74
De novo reflux	2/9	3/15 (20)	0.89
Second intervention	5/11	9/20 (45)	0.98
PN, n/N
Febrile UTI	1/5	1/8	0.71
Postoperative reflux	2/3	1/4	0.27
De novo reflux	2/3	0/4	0.053
Second intervention	0/5	1/8	0.41