From the Guidelines
A ureterocele is a significant medical condition that can cause urinary tract obstruction and increase the risk of urinary tract infections (UTIs) and kidney damage. According to the study by Huang et al 1, a ureterocele was found in 5 out of 390 patients (1.3%) with a history of UTIs, highlighting its importance as a potential underlying cause of recurrent infections. The study also noted that ureteroceles can be associated with other urinary tract abnormalities, such as hydronephrosis and double collecting systems.
Clinical Significance
The presence of a ureterocele can lead to:
- Urinary tract obstruction, which can cause flank pain, nausea, and vomiting
- Increased risk of UTIs, which can lead to sepsis and kidney damage if left untreated
- Kidney damage, which can result in chronic kidney disease or kidney failure if not properly managed
Diagnosis and Management
Diagnosis of a ureterocele typically involves imaging studies, such as ultrasound or CT scans, to visualize the urinary tract and identify any abnormalities. Management of a ureterocele may involve surgical intervention to correct the obstruction and prevent further complications. Early diagnosis and treatment are crucial to prevent long-term kidney damage and improve quality of life 1.
Key Findings
- Ureterocele is a relatively rare condition, but it can have significant clinical implications if left untreated
- Imaging studies, such as ultrasound, can help diagnose ureteroceles and other urinary tract abnormalities
- Surgical intervention may be necessary to correct the obstruction and prevent further complications 1.
From the Research
Definition and Classification of Ureterocele
- A ureterocele is a cystic dilatation of the intravesical ureter that is most commonly observed in females and children, and usually affects the upper moiety of a complete pyeloureteral duplication 2.
- Ureteroceles are divided into intravesical, when the ureterocele is completely contained inside the bladder, and extravesical when part of the cyst extends to the urethra or bladder neck 2.
Clinical Presentation and Diagnosis
- Severe, febrile urinary tract infection is the most common postnatal presentation of ureteroceles, but they may, rarely, prolapse and acutely obstruct the bladder outlet 2.
- Ureteroceles can also present with chronic intractable abdominal pain, as reported in a case study of a 43-year-old woman 3.
- Diagnosis of ureterocele typically involves sonographic screening, followed by a voiding cystourethrogram to detect vesicoureteral reflux (VUR) and a 99m-technetium dimercapto-succinic acid renal scan to evaluate the function of the different portions of the kidney 2.
Treatment and Management
- Simple endoscopic puncture of the ureterocele has been advocated as an emergency therapy for infected or obstructing ureteroceles and as an elective therapy for intravesical ureteroceles 2.
- Treatment of ectopic ureteroceles is more challenging and may require additional surgery at the bladder level, including upper pole partial nephrectomy and ureterocele removal and reimplantation of the ureter(s) 2, 4.
- Lower urinary tract reconstruction is an important aspect of surgical treatment for ureterocele, especially in patients with ectopic ureteroceles, to correct vesicoureteral reflux and bladder outlet pathology 5.
- Transurethral unroofing of the ureterocele is a safe and minimally invasive approach for adult ureteroceles, as reported in a case study of a 30-year-old female patient 6.
Complications and Outcomes
- VUR in the lower pole is observed in 50% of cases and in the contralateral kidney in 25% 2.
- The rate of additional surgery after elective endoscopic puncture of an orthotopic ureterocele ranges from 7 to 23%, while the reoperation rate after endoscopic treatment of ectopic ureteroceles varies from 48 to 100% 2.
- Postoperative urinary tract infections and voiding dysfunction are potential complications of surgical treatment for ureterocele, as reported in several studies 2, 4, 5.