Abstract

G Janardhan Goud*

This retrospective study aims to comprehensively examine the epidemiological and clinical aspects of ureterocele in adult patients and to discuss therapeutic modalities. The investigation covers a meticulous analysis of medical records from 11 adult patients treated for ureterocele over a 3-year period (2020-2023) at Mamata Medical College.

Objective: The primary objective of this study is to present a detailed understanding of the epidemiological and clinical characteristics of ureterocele in adults and to discuss various therapeutic modalities employed in managing this condition. Patients and methods: A rigorous retrospective analysis of medical records was conducted for adult patients diagnosed with ureterocele during the 3-year period from 2020 to 2023 at Mamata Medical College. The parameters under scrutiny encompassed epidemiological factors, clinical manifestations, paraclinical findings, therapeutic interventions and the evolution of the condition.

Results: The cohort consisted of 11 patients, with an average age of 36.3 ± 12 years, comprising six women and five men. The mean time of consultation ranged from 12 to 36 months. Clinical symptoms prompting consultation included atypical back pain (n=3), renal colic (n=2), and pelvic pain (n=2). Diagnostic procedures comprised ultrasound (n=7), intra venous urography (n=5) and CT urography (n=2). Ureterocele was bilateral in 2 cases and unilateral in 9, all classified as type A according to Brueziere (1). In one case, ureterocele was complicated by calculus formation, necessitating litholapaxy. In cases of complicated and/or symptomatic ureteroceles, endoscopic treatment was the chosen therapeutic modality. Specifically, 11 cases underwent a "smiling mouth" meatotomy involving a transverse horizontal incision, with concurrent management of any associated complications. The mean operative time for this procedure was 35 minutes (10-90). Operative follow-up was uneventful in 9 patients, with complications occurring in 1 patient (hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months, revealing that 1 patient developed vesicoureteral reflux, while no stenosis was noted.

Conclusion: In conclusion, ureterocele, although an uncommon urinary tract malformation in adults, often presents as a single ureter. The therapeutic approach in this study involved endoscopic treatment, specifically the "smiling mouth" meatotomy and litholapaxy in select cases, proving to be a viable and minimally invasive option for adult ureterocele. This approach demonstrated low morbidity rates and satisfactory results upon review, highlighting its potential as an alternative to conventional ureterovesical implantation.