URETEROCEL

E
BY
AMR MOHAMED AHMED
DEFINITION
-A ureterocele is a sacculation of the terminal portion
of the ureter.
.-A ureterocele is a birth defect
INCIDENCE
Ureteroceles occur in about 1 in 500 to 1 in -
4,000 people.
-More in female than male
-bilateral in 10%
Ectopic ureteroceles are four times more -
common than those that are intravesical
 Etiology
Ureterocele has been attributed to delayed or -
incomplete canalization of the ureteral bud leading
to an early prenatal obstruction and expansion of
the ureteral bud prior to its absorption into the
. urogenital sinus
The cystic dilation forms between the superficial and -
. deep muscle layers of the trigone
Large ureteroceles may displace the other orifices, or -
.even obstruct the bladder outlet
CLASSIFICATION
Ectopic
-Some part extends to the bladder
neck or urethra
-associated often with duplicated
ureter

Intravesical
-Confined within the bladder
-associated often with single ureter
CLINICAL PICTURE
Urinary tract infection-1
Lump (mass) in the abdomen that can be felt- 2
prolapsing from urethra-3
urinary incontinence-4
urinary obstruction-5
Abdominal pain-6
Hematuria- 7
Frequent and urgent urination-8
Ureteral calculus- 9
Diagnostic
Procedures
A) Laboratory Studies )
Urinalysis-
Urine culture-
Complete blood cell count-
Serum chemistries, especially BUN and serum -
creatinine
Blood cultures-
Fungal cultures: obtained in infants who have -
been on long-term antibiotic therapy or in
immunocompromised patients with clinical
evidence of UTI
B) Imaging Studies )

Large ureteroceles are usually diagnosed earlier

than smaller ones. A ureterocele may be
discovered before the baby is born (during a
(.pregnancy ultrasound
Some people with ureteroceles do not know they
have the. Often, the diagnosis is made later in
.life due to kidney stones
The following tests may be performed:
1- Ultrasonography
The cyst within a cyst is a pathognomonic
.radiologic sign of ureterocele
Voiding - 2
cystourethrograph
y
It may demonstrate reflux into
the lower pole or
.contralateral ureter
Intravenous urography - 3
Useful for delineating renal anatomy and -
providing a subjective estimation of relative
renal function
:-The following may be seen on IVP-
• Hydronephrosis, revealing dilatation of
collecting system
• Hydronephrotic upper pole displacing the
lower pole moiety laterally and inferiorly
• Ureteral displacement by the hydroureter
• Cobra-head extension of the distal ureter
(ureterocele)
Magnetic resonance imaging -4
Excellent anatomical study for evaluating rare cases
with suspected dysplastic, nonfunctioning, ectopic
renal moieties and ectopic ureteral insertion

Nuclear renal scan -5

It is helpful for estimating renal function
CT scanning of the abdomen and - 6
pelvis
-Used if U/S or IVU are equivocal
-Can reveal the presence of a duplicated collecting
.system, hydronephrotic upper pole segment

CT scan shows a right ureterocele within the bladder with contrast material filling the ureterocele . The
lucency on the left represents a Foley catheter
Cystoscopy - 7
Allow direct inspection and examination of the -
lower urinary tract
Used for confirm diagnosis and treatment -
 Treatment
A) Medical Therapy )
Observation alone is rarely a good option in -
symptomatic ureteroceles
Must rapidly initiate aggressive antibiotic -
therapy
Antibiotics should be instituted during the initial -
diagnostic evaluation and during surgical
intervention
 B) Surgical Therapy )

indications
obstruction especially bladder neck-
hydronephrosis-
loss of function-
UTI-

remember.....single system (non duplex) ureterocele is rare* *

Endoscopic incision

Definitive-

Risk = induced-
reflux
Upper pole nephrectomy
If no upper pole function
Uretero-ureterostomy
-an end-to-end
anastomosis of the
segments of the same
ureter, with excision of
the intervening injured or
scarred ureter
- Good upper pole
function, big ureterocele
En bloc reimplantation
-Good upper pole function,
small ureterocele
-if the patient has
significant vesicoureteral
reflux in the lower pole
- Both ipsilateral ureters
may be reimplanted within a
common sheath
Heminephroureterectomy
No upper pole function, obstructing
ureterocele