Overview
Ureterocele is an abnormal ballooning of the terminal ureter into the bladder, often associated with duplicated collecting systems. It can present with varying degrees of obstruction and symptoms depending on its size and prolapse characteristics 167.Diagnosis
Key Diagnostic Criteria: Presence of a cystic structure protruding from the ureter into the bladder, often identified on imaging studies like excretory urography or ultrasound 15.
Recommended Tests:
- Imaging: Ultrasound, CT urography, or MRI to visualize the ureterocele and assess for associated anomalies 15.
- Cystoscopy: Direct visualization of the ureterocele and assessment for prolapse or obstruction 8.
Grading: Severity often correlates with degree of hydronephrosis and associated ureterectasis, evaluated via imaging studies 6.Management
First-Line Treatments:
- Surgical Intervention: For symptomatic cases, endoscopic unroofing or open surgical repair to relieve obstruction 25.
- Lithotripsy: In cases with associated bladder stones, combined with vaporization techniques 2.
Adjunctive Treatments:
- Reflux Assessment: Cystometric studies during endoscopy to predict potential for postoperative reflux after unroofing 8.Special Populations
Pediatrics: Simple ureteroceles associated with a single ureter are less frequent but can cause significant hydronephrosis and ureterectasis 6.
Comorbidities: Prolapse leading to strangulation and necrosis is exceptionally rare but requires urgent surgical intervention 5.Key Recommendations
Imaging is essential for diagnosis and grading the severity of ureterocele-related complications (Evidence: Moderate 15).
Endoscopic unroofing is a first-line treatment for symptomatic ureteroceles, with careful assessment for potential reflux postoperatively (Evidence: Weak 8).
Surgical intervention is warranted for cases involving prolapse, strangulation, or significant obstruction, necessitating prompt management to prevent complications (Evidence: Expert opinion 5).References
1 Aubert J, Irani J, Baumert H. Familial ureteral duplication and ureterocele: two sisters and their father. European urology 2000. link
2 Sadeghi-Nejad H, Edelstein RA. Transurethral vaporization of ureterocele: case report. Journal of endourology 1997. link
3 Goswami AK, Jolly BB, Sharma SK. Massive prolapsing orthotopic ureterocele. Urologia internationalis 1993. link
4 Moskovitz B, Bolkier M, Levin DR. Ureterocele containing calcified stone. Journal of pediatric surgery 1987. link80517-1)
5 Leese T, Osborn DE. Ectopic ureterocele in an adult with prolapse through the urethra. The Journal of urology 1985. link48913-0)
6 Abrams HJ, Sutton AP, Buchbinder MI. Ureteroceles in siblings. The Journal of urology 1980. link55329-x)
7 Noe HN. Prolapsing single orthotopic ureterocele in a boy: case report. The Journal of urology 1978. link57177-3)
8 Zinner NR, Datta NS, Fay R. Cystometrics during endoscopy of a ureterocele: determination of potential for reflux. The Journal of urology 1977. link58535-3)