The management of ureteroceles in infants has taken an interesting historical twist. Several decades ago, initial management for ureteroceles was often endoscopic unroofing. Although usually effective in the short term, these babies almost always developed vesicoureteral reflux and its attendant problems of recurring, febrile urinary infection. This procedure was subsequently abandoned in favor of more open surgical reconstruction. Currently, however, modern endoscopic equipment and more judicious incision (not unroofing) of ureteroceles allow for decompression of the upper tracts without necessarily developing reflux, and appropriate modern antimicrobial chemoprophylaxis can prevent most urinary tract infections. Today, endoscopic decompression of ureteroceles, especially in newborns, is seen as an important initial therapeutic approach. It offers definitive therapy in a few situations and allows for elective reconstruction, when necessary, in the remainder. Ureteroceles can be described as intravesical or extravesical, regardless of whether the ureterocele is associated with a single or duplex ureter. Endoscopic decompression is most likely to be definitive for those ureteroceles wholly contained within the bladder (intravesical), especially if reflux is not present in the other ureters.
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