Ureterocele

A ureterocele is a birth defect that affects the kidney, ureter, and bladder. When a person has an ureterocele, the portion of the ureter closest to the bladder swells up like a balloon and the ureteral opening is often very tiny and can obstruct urine flow. This blockage can affect how the part of the kidney affected develops and works.

Types of Ureterocele

  • Ectopic: when a portion protrudes through the bladder outlet into the urethra
  • Orthotopic: when they remain entirely within the bladder
  • Bilateral: when there is an ureterocele on both sides, which happens in 5 to 10 percent of cases

The majority of ureterocele are diagnosed in children less than 2 years, although occasionally older children or adults are found to have an ureterocele.

What Are Some Complications of a Ureterocele?

  • Increased risk of kidney infection
  • Vesicoureteral reflux, or when urine flows backward from the bladder reflux into the opposite kidney
  • May prevent the passage of kidney stones
  • Urine cannot pass from bladder to urethra

What are Symptoms of a Ureterocele?

Usually there are no symptoms that accompany an ureterocele, but some patients experience:

  • Flank or back pain
  • Urinary tract infection
  • Fever
  • Painful urination
  • Foul-smelling urine
  • Abdominal pain
  • Blood in the urine (hematuria)
  • Excessive urination 

How is a Ureterocele Diagnosed?

  • Many children with ureteroceles are now identified during fetal ultrasounds performed before birth, but they may not be diagnosed until a patient is being evaluated for another condition such as a urinary tract infection
  • Ultrasonography is used to allow radiologists to diagnose a ureterocele
  • A bladder test, the voiding cystourethrogram (VCUG), is usually performed to define the type of ureterocele, the effect on bladder function and if there is any reflux into any of the ureters
  • Renal scan (DMSA or MAG-3) is often performed to evaluate the function of the kidneys, specifically to determine whether the affected portion of the kidney has any function
  • Abdominal CT scans and MRI tests are additional studies that may also be performed in situations where the urinary tract anatomy is extremely ambiguous and will allow the surgeon to better identify anatomical variations

Treatment

The treatment for a ureterocele is based on the age of the patient, whether the affected portion of the kidney is functioning, and whether vesicoureteral reflux is present. In some cases, more than one procedure is necessary, while in unusual cases, observation, or no treatment, may be recommended.

Children’s National offers five techniques to treat ureterocele. Each child is unique and the medical team will work with the family to determine the best option.

  • Transurethral puncture: A form of minimally invasive therapy that punctures and decompresses the ureterocele using a cystoscope that is inserted through the urethra.
  • Upper pole nephrectomy: If the upper half of the kidney (the part associated with the ureterocele) does not function because of the ureterocele and there is no vesicoureteral reflux, removal of the affected portion of the kidney is recommended. This can be done with open surgery, laparoscopic surgery, or robotic surgery.
  • Nephrectomy: If the entire kidney does not function because of the ureterocele, removal of the kidney is recommended. This can be done with open surgery, laparoscopic surgery or robotic surgery.
  • Removal of the ureterocele and ureteral reimplantation: If it is deemed necessary to remove the ureterocele, then an operation is performed in which the bladder is opened, the ureterocele is removed, the floor of the bladder and bladder neck are reconstructed and the ureters are reimplanted to create a non-refluxing connection between the ureters and the bladder. This can be done with open surgery, laparoscopic surgery, or robotic surgery.
  • Ureteropyelostomy or upper-to-lower ureteroureterostomy: If the upper portion of the ureter shows significant function, one option is to connect the obstructed upper portion to the non-obstructed lower portion of the ureter or pelvis of the kidney. This can be done with open surgery, laparoscopic surgery, or robotic surgery.
Source: http://www.urologyhealth.org/urology/index.cfm?article=42
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At Children’s National in Washington, DC, our pediatric urologists provide comprehensive care for disorders affecting reproductive and urinary organs.

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