Ureterocele

Ureterocele is a congenital urological anomaly in which the distal end of ureter (that empties into the urinary bladder) balloons up to block the flow of urine. This congenital disorder affects 1 in 500 to 1 in 4,000 babies in the US each year.

What Causes Ureterocele?

In any normal individual, kidneys produce urine which is carried via ureters (right and left) to the urinary bladder. Each ureter empties into the urinary bladder via opening. If the opening is extremely small or blocked, the urine produced by kidneys tend to accumulate; thereby forming ureterocele.

It appears as a sac or pouch like swelling along the anterior aspect of urinary bladder (at the site of entry of ureter). The swelling is the result of collection of urine in the ureter due to incomplete emptying into the bladder. Urine can also flow back into the bladder leading to urinary reflux.

What Are Some Classic Symptoms Of Ureterocele?

The presentation of Ureterocele vary from person to person, depending on various factors like; site of ballooning, severity of condition and age of patient. Characteristic symptoms of this disease are:

• Pain in the lower abdomen
• Pain along the side of the abdomen, flanks or at the back
• Recurrent episodes of severe spasmodic pain that may radiate to the genitals, groin and thigh region
• Appearance of blood in the urine
• High fever with rigors and chills
• Urine with foul smell
• Increase in the frequency and urgency of urination
• Feeling of a lump inside the abdomen.
• Prolapse of ureterocele into the vagina
• Urinary Incontinence
• Recurrent episodes of complicated UTI (Urinary tract infection)

What Are Some Complications Of Poorly Managed Ureterocele?

Clinical data indicates that delay in managing the symptom or treating the condition may culminate in a variety of complications; such as

• Damage to the bladder leading to incontinence of urine or urinary retention.

• Damage to the kidney or complete loss of renal function.
• Recurrent attacks of UTI.
• Urothelial carcinoma is a rare but serious complication of poorly managed ureterocele.

Exams And Assessments

The diagnosis of relatively larger ureterocele is made earlier than the smaller ones. In most cases, your doctor can detect it in the antenatal ultrasound examination of the baby.

The symptoms of ureterocele are difficult to understand and that’s why most cases of smaller ureterocele are diagnosed later in life when complications begin to appear (such as stone formation or chronic infections of kidney).

The blood in urine or UTI symptoms can be diagnosed by urinalysis.

Some tests that are recommended for early identification are:

• Ultrasound of the abdomen.
• Abdominal CT scan.
• Internal examination and testing of bladder- Cystoscopy.
• Radionuclide renal scan.
• Voiding cystourethrogram (3).

Treatment Of Ureterocele

The goal of ureterocele treatment is to provide relief from the symptoms of urinary obstruction and to preserve the renal function. The treatment is usually surgical and aims to remove the obstruction from the affected area of ureter. Doctors usually recommend the drains to be placed inside the ureter or in the renal area to provide relief for the limited time. In some cases, when surgical intervention is not an option, daily low dose antibiotic therapy can be recommended to minimize the risk of urinary tract infections.

Various surgical techniques are available to manage the this disease; for example:

• A small incision is usually made to completely remove the tissue that is causing obstruction.
• Surgeons also prefer to excise the ureter to remove the damaged tissue before reattaching the ureter to the bladder.
• Laser surgeries can be performed in fetuses to correct ureterocele.

Various criteria needs to be considered before deciding the surgical technique and type of surgical procedure; such as age of patient, site and extent of obstruction and overall health of the patient.

What Should You Know About The Prognosis Of Ureterocele?

The results of these surgeries differ in nature and there is no guarantee that the disease will be cured. Some might face temporary damage if the blockage is curable, while others may face permanent damage to their kidneys.

References

1. Paye-Jaouen, A., Pistolesi, F., Botto, N., Enezian, G., Grapin-Dagorno, C., Peycelon, M., & El-Ghoneimi, A. (2015). Long-term bladder function after ureterocele decompression in children. The Journal of urology, 193(5), 1754-1759.

2. Astigueta, J. C., Abad-Licham, M., Silva, E., Alvarez, V., Piccone, F., Cruz, E., & Redorta, J. P. (2016). Urothelial carcinoma: managing a rare presentation. ecancermedicalscience, 10.

3. Torres Montebruno, X., Martinez, J. M., Eixarch, E., Gómez, O., García Aparicio, L., Castañón, M., & Gratacos, E. (2015). Fetoscopic laser surgery to decompress distal urethral obstruction caused by prolapsed ureterocele. Ultrasound in Obstetrics & Gynecology, 46(5), 623-626.