Ureterocele

• Ureterocele is a cystic dilatation of the distal ureter.
• Cobra head or Adder head appearance is diagnostic of ureterocele.
• Spider leg appearance in polycystic kidney.

Ans.D. Ureterocele

IVP in ureterocele usually shows a round filling defect, sometimes large, in the bladder corresponding to the ureterocele, and characteristic finding of duplication of the collecting system (ureteroceles are nearly always associated with ureteral duplication).

Ureterocele :

•  Is a cystic dilatation of the terminal ureter and is obstructive because of a pinpoint ureteral orifice.
•  It is more common in females.
•  Affected children often are discovered by prenatal sonography or during an investigation of UTI (IVP).
• Treatment: transurethral incision of ureterocele: effectively relieves the obstruction but it may result in V.U.R. necessitating ureteral reimplantation later, or
• Open excision of ureterocele and reimplantation ‘as primary management’.
• About other options-
•  An isolated VUR or Duplication of ureter do not explain the filling defect in the bladder.
•  Sacrococcygeal Teratoma :
• The most common presentation here is with an abnormal, obvious protruding mass from the sacral area. Out of the 4 varieties known, only Type IV which contributes 9.8 % ie entirely pre-sacral and not visible externally (90.8% of tumours are visible externally).

      Bladder and Rectum may be displaced anteriorly but a filling defect is not characteristic as in ureterocele.

      Ureters may be partially obstructed resulting in hydro-ureter and hydronephrosis.

Ans. is ‘a’ i.e. Ureterocele 

The ‘adder head or ‘cobra head’ appearance on excretory urography is noted in Ureteroceles

• Ureterocele is a ballooning of the distal submucosal ureter into the bladder.
• Ureterocele is thought to result from congenital atresia of the ureteric orifice.
• Although present from childhood the condition is often unrecognized until adult life.
• It may get large enough to obstruct the vesical neck or the contralateral ureter.
• It is more common in females
• 10% cases are bilateral
• Often associated with duplicate ureters (always involves the ureter draining the upper renal pole)
• Almost always associated with significant hydroureteronephrosis

Ans. is ‘c’ i.e., Ureterocele 

• Ureterocele is a ballooning of the distal submucosal ureter into the bladder.
• Ureterocele is thought to result from congenital atresia of the ureteric orifice.
• Although present from childhood the condition is often unrecognized until adult life.
• It may get large enough to obstruct the vesical neck or the contralateral ureter.
• It is more common in females
• 10% cases are bilateral

Ans. D: Ureterocele

Ans:C.)Ureterocele.

The image shows an Intravenous Urogram showing the bladder filled with contrast material and the dilated left ureter inserting into the bladder. The rim of radiolucency surrounding the insertion of the left ureter into the bladder is diagnostic of a ureterocele. This is called the cobra-head deformity..

Ureterocele

• 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 can include:
  • 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, but 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 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.