Endoscopic Management of Ureterocele Associated with Stone in a Child

Melinda SAJTHY1, Bálint SULYA1, Péter NYIRÁDY2,
András KISS1, Miklós MERKSZ1

1Department of Urology, Heim Pál Children’s Hospital, Budapest, Hungary
2Department of Urology, Semmelweis University, Budapest, Hungary

Introduction: Ureterocele diagnosed in childhood is generally
associated with duplex system. In these cases the ureterocele is
sitting on the orifice of the ectopic ureter causing dilatation in
the corresponding moiety, but sometimes even contralaterally as
well. If surgical management is needed, the primary intervention
depends on the concrete case and on the preferred therapeutic
approach of the surgeon (e.g. upper pole heminephrectomy or
transurethral incision of the ureterocele, TUI). Single system
ureteroceles are rare in children, approx. 10 % of the cases.
Furthermore, in pediatric population stones are found very seldom
found in duplex or in single system ureteroceles. We
describe the successful management of a child with a stone in a
ureterocele.

Patients and methods: A 6-year old girl was examined at the
local health centre for abdominal pain and vomiting. Abdominal
ultrasound revealed 10×10 mm ureterocele on the left side associated
with a single system and containing a stone 9×6 mm in
size. No ureteral dilatation was seen, both kidneys appeared normal.
The child was referred to our hospital. At cystoscopy the
wall of the ureterocele seemed edematous. After TUI the coarse,
tawny, fragile stone was removed. The stone was composed by
calciumoxalate-dihydrate. The post-operative period was
uneventful, no recurrent stone, VUR or dilatation was found at
follow-up.

Discussion: Endoscopic incision of a ureterocele is generally
accepted in the treatment of ureteroceles associated with duplex
systems in children. It has been recommended by many experts
as an initial and in the majority of the patients, as a definitive
procedure. However, in the literature no publication is seen
about TUI done for the removal of a stone developed in a ureterocele
in a child. In our patient with this minimally invasive
method – which could be done even on outpatient basis – total
recovery was achieved.