Outcome of patients with prenatally detected duplex system ureterocele; natural history of those managed expectantly.

Purpose: We assessed the outcome of patients treated for prenatally detected duplex system ureterocele with particular reference to those treated expectantly.

Materials And Methods: We reviewed the records of 52 consecutive patients treated between 1984 and 1999 with a median followup of 8 years (range 1 to 16.2).

Results: Of the 38 patients who underwent surgical treatment 13 subsequently required unplanned secondary procedures. A total of 14 cases satisfying currently defined criteria, including less than 10% upper renal pole function, an unobstructed lower pole (absent nonrefluxing hydroureteronephrosis), lower pole vesicoureteral reflux not exceeding grade III and unobstructed bladder outflow, were managed expectantly with a median followup of 8 years (range 1.6 to 12.8). In this group of patients prophylactic antibiotics were routinely prescribed until the completion of toilet training or age 5 years in those with persistent reflux on repeat cystography. None has required surgery or had symptoms or urinary infection. In 6 cases followup ultrasonography showed substantial resolution of upper pole hydronephrosis with a collapsed ureterocele. Furthermore, 7 of the 38 patients who underwent surgical treatment early in our series would have been treated expectantly had the current criteria been applied.

Conclusions: In 14 of the 52 patients (approximately 27%) with prenatally detected duplex system ureterocele the natural history of the complaint is essentially benign within the currently available followup.