The timing and type of treatment used are based on a few things:
- The age and health of the patient
- Whether or not the kidney is affected
- Whether or not VUR is present
Sometimes, more than one procedure is needed. Sometimes, observation (no treatment) may be recommended.
The following are treatment options:
With this treatment, the ureterocele is punctured and decompressed. To do this a cystoscope (a thin tube with camaera and light on the end) is used. It usually takes 15 to 30 minutes and can be done without an overnight stay in the hospital. This treatment doesn't use a large incision. But, if the ureterocele wall is thick, it may not work. If it doesn't work, an open operation may be needed. Also, there is a slight risk of causing an obstructive flap valve. This would make it difficult to urinate. This treatment works best when the ureterocele is within the bladder (orthotopic).
Upper Pole Nephrectomy
In some cases, the upper half of the kidney does not function from a ureterocele. If there is no urine reflux in the second ureter, the damaged part of the kidney may be removed. Often, this operation is done either through a small cut under the ribs, or laparoscopically.
If the entire kidney does not work because of the ureterocele, it must be removed. Usually this can be done laparoscopically. Sometimes a small incision is needed.
Removal of the Ureterocele and Ureteral Reimplantation
If the ureterocele must be removed, then an operation is done. For this surgery, the bladder is opened, the ureterocele is removed, the floor of the bladder and bladder neck are rebuilt, and the ureteral flap valve recreated to prevent urine from flowing backward to the kidney. The operation is done with a small incision in the lower abdomen. It is a complex surgery, but it is successful 90-95% of the time.
Ureteropyelostomy or Upper-to-Lower Ureteroureterostomy
If the upper part of the ureter works well, and there is no reflux in the lower part ureter, one option is to connect the obstructed part to the non-obstructed part of the ureter or kidney. The operation is done with a small incision in the lower abdomen. The success rate is 95%.
Antibiotics are used to fight bacteria and prevent kidney infection. A child with a possible urine block or urine reflux may be given antibiotics to prevent infections until the defect is corrected.