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Predictors of Success and Failure in Patients UndergoingPrimary Endoscopic Intervention for Ureterocele
Jordan L. Mendelson, MD1, Cristian Mathew, BS2, Maxwell Efros, MD1, Diego R. Alvarez Vega, BS3, Katharine Hodgen, MD1, Shreya Patel, BS4, Katherine Bascobert, BS1, Ronnie Fine, MD1, Mark Horowitz, MD1, Israel Franco, MD5, Jordan Gitlin, MD1.
1NYU Langone Hospital-Long Island, Mineola, NY, USA, 2SUNY Downstate Health Sciences University College of Medicine, Brooklyn, NY, USA, 3NYU Grossman Long Island School of Medicine, Mineola, NY, USA, 4Albany Medical College, Albany, NY, USA, 5University of Tennessee Medical College-Chattanooga, Chattanooga, TN, USA.
BACKGROUND: It remains unclear exactly which risk factors associated with ureterocele confer an increased risk of endoscopic treatment failure. In this study, we set out to identify risk factors associated with primary endoscopic treatment failure.
METHODS: We conducted an IRB-approved, retrospective review of all pediatric patients diagnosed with ureterocele from March 2008 - April 2024 at one institution. Data was collected on patient demographics, anatomical factors, presence of vesicoureteral reflux (VUR) and/or hydronephrosis, UTIs, and need for second surgery. Exclusion criteria included bilateral ureteroceles, lack of primary endoscopic treatment, insufficient clinical follow-up, and/or otherwise incomplete medical records. Statistical analyses were then conducted using chi-square tests, Fisher’s exact test, and multivariate logistic regression on R-Studio.
RESULTS: 139 total patients were diagnosed with ureterocele over the time period specified. 76 patients met inclusion criteria. Patients with ureteroceles associated with an ipsilateral duplicated collecting system were more likely to develop post-operative VUR (p<0.0001). Post-operative VUR increased the likelihood of developing at least one UTI (p=0.037). 32 patients overall (42.1%) required a second surgery. Risk factors associated with a second surgery included an ipsilateral duplicated collecting system (p=0.0006), ectopic ureterocele (p = 0.004), presence of pre-operative VUR (p = 0.009), and evidence of pre-operative urethral obstruction (p = 0.003).
CONCLUSIONS: Ipsilateral duplicated collecting system, ectopic insertion site, presence of pre-operative VUR, and pre-operative VCUG evidence of urethral obstruction were found to be risk factors for primary treatment failure and the need for a second surgery.
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