Ectopic ureterocele: Clinical application of classification based on renal unit jeopardy

Purpose: The Churchill classification system grades the ectopic ureterocele based on the number of renal units in jeopardy. We apply this system to our experience to help predict response to initial surgical intervention. Materials and Methods: All cases of ectopic ureterocele diagnosed at our institution between 1990 and 2000 were retrospectively reviewed and categorized using the Churchill classification system. Initial surgical procedure and subsequent outcomes were analyzed. Results: A total of 53 patients were identified, of whom 42% had only upper pole involvement (grade 1), 40% ipsilateral upper and lower pole involvement (grade 11) and 19% bilateral renal involvement (grade III). Endoscopic incision was definitive in 56% of grade 1, 20% of grade 11 and no grade III ureteroceles. An upper tract approach was definitive in 85% of grade 1, 45% of grade 11 and no grade III ureteroceles. An initial lower tract procedure was successful in 80% of grade II and 100% of grade III ureteroceles. Overall the initial surgical procedure was definitive in 73% of grade 1, 48% of grade II and 20% of grade III ureteroceles. Conclusions: Our results confirm the findings of Churchill. In this series the majority of grade I ureteroceles were successfully managed with an upper tract procedure. However, high grade ureteroceles were more likely to require a secondary operation unless an initial lower tract reconstruction was performed.