Management of ureterocele in neonates

UTI: urinary tract infection; VCUG: voiding cystourethrogram; VUR: vesicoureteral reflux.

* Infants with sepsis due to urinary tract obstruction require immediate drainage of the kidney, typically via endoscopic incision.

¶ Antibiotic prophylaxis initially consists of amoxicillin (10 to 15 mg/kg orally once daily). At age 2 months, we generally switch to either trimethoprim-sulfamethoxazole or nitrofurantoin. For those with single collecting systems and no hydroureter, antibiotics and monitoring can be discontinued after 1 year of age if no VUR, and after toilet training if mild or moderate VUR.

Δ VCUG is ideally performed at 2 to 4 weeks of life, with the infant on prophylactic antibiotics. If there are concerns for lower urinary tract obstruction (eg, bilateral hydronephrosis, bilateral ureteral dilation and/or dilated bladder, or thickened bladder wall), perform VCUG as soon as possible to ensure prompt diagnosis and treatment of the obstruction.

◊ For patients with intermediate risk, our practice is to perform initial endoscopic decompression to reduce risk of sepsis and to facilitate future reconstructive surgery by decreasing the caliber of the dilated ureter. Some other experts manage expectantly, with prophylactic antibiotics and serial ultrasounds.

§ Expectant management consists of periodic reassessment with ultrasound every 4 months for the first year of life. Prophylactic antibiotics should be given for all patients, except for those with small, single-system intravesicular ureteroceles and no hydronephrosis or VUR.

¥ Renography should be performed for all patients with duplex systems (which is present in 80% of those with ureterocele) and also for those with severe hydronephrosis or kidney size discrepancy. Renography measures function in the affected kidney segment and is performed at approximately 4 to 6 months of age.