Pediatric 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.

• 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

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

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.

• Abdominal ultrasound. A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through various vessels.
• Voiding cystourethrogram (VCUG). A specific X-ray that examines the urinary tract. A catheter (hollow tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body) and the bladder is filled with a liquid dye. X-ray images will be taken as the bladder fills and empties. The images will show if there is any reverse flow of urine into the ureters and kidneys.
• Mag-3 diuretic renal scan. A diagnostic nuclear imaging technique that is conducted by injecting a radioactive fluid into the vein. The radioactive material is then carried to the kidneys where it gives off signals that can be picked up by cameras. Midway during the procedure a diuretic medication is given to speed up urine flow through the kidneys. This helps detect any area of blockage in the urinary tract.

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.