# Conservative Management and Safe Discontinuation of Continuous Antibiotic Prophylaxis in a Child With an Ectopic Ureterocele: An Eight-Year Follow-Up Case Report and Literature Review

## TL;DR

A child with an ectopic ureterocele was successfully managed without surgery through conservative observation and imaging, avoiding unnecessary procedures.

## Contribution

The case provides safe criteria for conservative management and discontinuation of antibiotic prophylaxis in asymptomatic infants with ectopic ureteroceles.

## Key findings

- The ureterocele size decreased over time with no febrile UTIs or renal impairment.
- Conservative management with imaging was safe and effective for eight years.
- Antibiotic prophylaxis could be safely discontinued after toilet training.

## Abstract

An ectopic ureterocele is a rare congenital anomaly often managed surgically due to risks of urinary tract infections (UTIs), hydronephrosis, and renal impairment. Yet there is no consensus on selecting surgical or conservative observation therapy. A girl was diagnosed antenatally with a left ectopic ureterocele. Postnatal evaluation confirmed hydronephrosis, and at three months of age, voiding cystourethrography demonstrated the ureterocele without vesicoureteral reflux. At the routine six-month ultrasound, the ureterocele was noted to be smaller than at diagnosis. A follow-up magnetic resonance urography and mercaptoacetyltriglycine scintigraphy at eight months revealed further reduction in ureterocele size, improvement in hydronephrosis, and preserved differential renal function. Based on these findings and the absence of febrile UTIs, the initially planned surgery was cancelled. The patient remained asymptomatic, with negative urine cultures and stable renal function. Continuous antibiotic prophylaxis (CAP) was maintained until toilet training at three years of age, after which it was safely discontinued. By eight years of age, the ureterocele had remained stable, and the patient had no febrile UTIs or urinary symptoms.

This case illustrates that conservative management with sequential imaging can be a safe alternative to early surgery in asymptomatic infants. Our findings suggest that surgery should not automatically be performed at diagnosis but reconsidered in light of sequential imaging and renal function. In asymptomatic infants, an observation period of at least two to three months may be safely undertaken to evaluate the natural course. The combination of shrinkage, absence of infection, and preserved renal function supported long-term conservative management in this patient, contributing to defining safe criteria for conservative observation and CAP discontinuation.