Ureterocele and urolithiasis

Abstract

We studied 51 patients with true ureterocele (primarily, orthotopic
and unilateral - 84.3 and 82.3%, respectively) combined with
urolithiasis. Mean age of the patients was 41.9±2.0 years, size of ureterocele - 20.7±1.3 mm
and mean concrement area - 1.4±0.2 cm2.
In adult patients with orthotopic or heterotopic disease urgery consisted
of perforation (n = 5) or dissection of ureterocele wall (n =38).
Endoscopic operations were indicated in small and middle sized
ureterocele (less than 30 mm in size), unaffected contractility of terminal
ureter, moderate urodynamic disorders of the upper urinary
tracts, normal function of the kidney and no pyelonephritis exacerbation.
Endoscopic section of ureterocele wall combined with ureterolithoextraction (n = 26),
contact ureterolithotripsy using Ho:YAG
laser or ultrasound (n = 19). Open surgery (ureterocystoneostomy by
Politano-Leadbetter was made in orthotopic ureterocele over 30 mm
in size and in marked urodynamic disturbances of the upper urinary
tracts (n = 6). At discharge, a complete elimination of the stones in
ureterocele patients was 81.6%. Effective use of extracorporeal shockwave
lithotripsy of nephroliths within 2 months after removal of ureterocele
raised this percent to 87.7. Thus, choice of surgical policy in
ureterocele complicated by urolithiasis depends on its size, variant of
combination of this defect with the concrement, anatomofunctional
state of the upper and lower urinary tracts, age of the patient and presence
of pyelonephritis.