BJU International (1999), 83, 1081–1082

CASE RE PORT

Endoscopic incision for the treatment of a ureteric valveS. NISHIO, H. HAMADA and M. YOKOYAMADepartment of Urology, Ehime University School of Medicine, Ehime, Japan

3 weeks. Postoperative ultrasonography and IVUCase report

revealed an almost normal left kidney. There was norecurrence of the left flank pain by the 36-monthA 7-year-old boy presented with a history of dull pain

in the left flank; IVU revealed a large hydronephrotic left follow-up.kidney with a filling defect in the upper ureter. Therewas no VUR and the diuretic renogram showed a left

Commentureteric obstruction and normal plasma flow in the leftkidney. The preoperative diagnosis was left hydroneph- The congenital ureteric valve is relatively rare; only 30

cases have been reported to date (17 males and 13rosis due to a ureteric polyp. A percutaneous endoscopicresection of the ureteric polyp was planned. Cystoscopy females, age range 10–94 years). Thirteen cases were

associated with other congenital abnormalities [1–3].revealed two normal ureteric orifices, and a retrogradepyelogram showed a filling defect of the upper ureter; The valve was on the left side in 16 cases, on the right

in 13 and bilateral in one case. Eleven were located inthe stenotic part of the ureter was tortuous (Fig. 1).A percutaneous nephrostomy dilated to 15 F was the upper ureter and the remainder in the lower ureter;

16 were annular, 13 were cusp-like and one was notplaced through the upper calyx and the filling defectvisualized using a multifunctional surgical endoscope described. Of 24 such patients who had undergone

surgical treatment, nephrectomy or heminephrectomy(Universaltome, 13.5 F, Takai Co., Japan). The irregu-larities were not polyps but rather a ureteric valve of an was performed in nine, and 15 were treated with excision

and end-to-end anastomosis. In the present case, theiris-like annular shape (Fig. 2). Using a hook-shaped coldknife, a 2 cm cut was made in the dorsal side of the ureteric stenosis was corrected by incision on the dorsal

side of the ureter. Endoscopic incision is thought to be avalve until the yellowish peritoneal fat was visible. A12 F indwelling endopyelotomy stent was used for useful treatment for the ureteric valve.

Fig. 1. A retrograde pyelogram at surgery shows a filling defect of Fig. 2. Endoscopic view of the left ureter shows the ureteric valve,iris-like and annular in shape.the upper ureter. The stenotic part of the ureter is tortuous.

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1082 CASE REPORT

References Authors

S. Nishio, MD, Associate Professor of Urology.1 Pourmand G, Kamalian N, Sohrabvand F. Congenital uretericvalve associated with renal dysgenesis. Br J Urol 1988; H. Hamada, MD, Urologist.

M. Yokoyama, MD, Professor of Urology.61: 362–632 Fried AM, Mulcahy JJ, Bhathena DB, OliC M. Hydronephrosis Correspondence: Dr S. Nishio, Department of Urology, Ehime

University School of Medicine, Ehime 791-0295, Japanwith ureteral valve: diagnosis by ultrasonography andantegrade pyelography. J Urol 1978; 120: 754–6

3 Sant GR, Barbalias GA, Klauber GT. Congenital ureteralvalves — an abnormality of ureteral embryogenesis? J Urol1985; 133: 427–31

© 1999 BJU International 83, 1081–1082