Variation in management of duplex system intravesical ureteroceles: a survey of pediatric urologists.

PURPOSE: Controversy exists in ureterocele management and the literature lacks clear management guidelines. We surveyed pediatric urologists to understand practice patterns and perceptions of managing duplicated system intravesical ureterocele.

MATERIALS AND METHODS: The survey consisted of 3 case scenarios, including upper pole obstruction without reflux, ureterocele without hydronephrosis and reflux after incision. The survey evaluated management at patient age 3 months and used a Likert scale to evaluate management strategies later in life.

RESULTS: We analyzed 233 responses. There was agreement in prophylactic antibiotic use and diagnostic evaluation. When managing a duplicated system intravesical ureterocele with poor upper pole function, 50.6% of respondents advocated puncture at age 3 months. However, when followed conservatively for 18 months, the preference changed to surgical management with partial nephrectomy preferred by 61.8% of respondents. When managing the condition without hydronephrosis, watchful waiting was preferred by 47.2% of respondents while 35.6% chose puncture and another 16.3% chose partial nephrectomy. Most respondents advocated ureteral reimplantation to manage reflux to the upper pole after puncture while some preferred endoscopic Deflux® injection. Continued nonoperative management while off prophylaxis was not preferred. Most respondents viewed the risks of surgery and anesthesia as important factors when weighing options in children younger than 3 months. Preventing symptoms and preserving function of the renal units were significant factors guiding surgical intervention.

CONCLUSIONS: We found significant variation in management of duplicated system intravesical ureterocele. Most pediatric urologists see fewer than 10 cases per year, stressing the need for multi-institutional, randomized, controlled studies to evaluate management and long-term outcomes.