Ureterocele

INTRODUCTION:

• It is a submucosal cystic dilation of the terminal segment of the ureter.
• A ureterocele may be classified  as intravesical, defined by its presence entirely within the bladder, or extravesical, defined by the permanent presence of some portion of the ureterocele at the bladder neck or urethra.
• Other classification systems for ureteroceles are based on the location of insertion of the ureter into the bladder (simple orthotopic and ectopic) or based on their association with a single or duplicated system.

SYMPTOMS:

• Frequent urinary tract infections
• Pyelonephritis
• Obstructive voiding symptoms
• Urinary retention
• Failure to thrive
• Hematuria
• Cyclic abdominal pain
• Urolithiasis
• Cobra head sign is seen in radiography
• In females: salpingitis, hydrosalpinx with sepsis or torsion.
• Redundant collection systems are usually smaller in diameter than single, and predispose the patient to impassable kidney stones.

INVESTIGATION:

• Ultrasonography is the most sensitive test for the detection of ureteroceles, showing Hydroureter and Hydronephrosisbut it may cause ureteroceles to be missed if the patient’s bladder is empty or fully distended, if the ureteroceles are small.
• CT scans, intravenous pyelograms, and renal scans are less sensitive for ureteroceles, but they help to more clearly delineate the functional anatomy of the kidneys.
• The classic finding on an intravenous urogram (IVU) is a round radiopacity in the bladder surrounded by a radiolucent rim. This is called the cobra-head or Adder head deformity.

TREATMENT:

• Single-system ureterocele: initial management is usually endoscopic incision of the ureterocele, which can be followed by surgical ureteric re-implantation to preserve renal function and prevent reflux.
• Duplex-system ureterocele: treatment options vary with the individual and include: endoscopic incision of the corresponding ureteric orifice in case of ureteric meatal stricture; upper pole nephrectomy for a poorly functioning unit with ureterectomy or, where there is useful renal function, ureteropyelostomy.

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