Ureterocele

Dr/ Hytham Nafady

Definition

• Cystic dilatation of the intra-vesical segment of the distal ureter.

Demographics

• Age:

• Present during adulthood (simple ureterocele).

• Present during childhood (ectopic ureterocele).

• Sex:

• F > M

Etiology

• Delayed canalization of Chwalla membrane during embryogenesis which causes obstruction of the ureteric orifice.

• (Chwalla membrane is a primitive membrane that separates the ureteric bud from the developing urogenital sinus).

Genetics:

• It is non inherited disorder.

Classification of urteroceles

Ureteroceles

Position

Intravesical Prolapsing

Location of ureteric orifice

Simple Ectopic

Renal collecting system

Single system

Duplex system

According to position

• Completely contained within the urinary bladder.

Intravesicalureterocele

• The uretercele prolapses into:

• The bladder neck (may cause bladder neck obstruction)

• The urethra (may emerge from the urethral orifice).

Prolapsing

(extravesical) ureterocele

Prolapsing ureterocele

Prolapsing ureterocele

According to the location of ureteric orifice

• The ureteric orifice is located at its normal anatomical position.

Simple(orthotopic)

25%

• The ureteric orifice is located outside its normal anatomic position (the bladder trigone).

Ectopic

75%

According to the renal collecting system

• Ureterocele draining single collecting system.

Single system

ureterocele

• Ureterocele draining the upper moiety of duplex kidney and inserts below and medial to the ureter draining the lower moiety (Weigert Meyer rule).

Duplex system

ureterocele

• Single system ureteroceles are usually simple.

• Duplex system ureteroceles are usually ectopic.

• Is the most common presentationInfection

• HydroureteronephrosisObstruction

• Hematuria.Stone formation

• Ectopic ureterocele drain beyond the bladder neck.

• More common in females.

Incontinence of urine

• Ectopic or prolpasing ureterocele Acute bladder neck

obstruction

Complications of ureterocele

Ureterocele stone

Ectopic ureterocele with bladder neck obstruction

Voiding cystourethrography

• Intra-vesical filling defect.

• Best demonstrated in early filling phase (faint contrast and low intravesical pressure).

• May undergo effacement with bladder distension (due to rising intravesical pressure).

• May undergo eversion during voiding (due to rising intravesical pressure). (evertingureterocele is seen as outpouching outside the bladder wall and mimic diverticulum).

VCUG of ureterocele

Early filling phase

VCUG of duplex system ureterocele with reflux into lower moiety

ureterocele

Reflux into lower moiety

Evertingureterocele

VCUG of duplex system

ureterocele with reflux into lower

moiety

IVP

• Dilated distal end ureter projecting into the lumen of the urinary bladder, with surrounding radiolucent rim.

Cobra head appearance

Associated hydronephrosis

Associated complete duplex kidney

• Non functioning ectopic ureterocele draining the hydronephrotic upper moiety

• Displacement of the lower moiety (Drooping Lilly sign)

Associated complete duplex kidney with hydronephrosis

of the upper moiety

Drooping Lilli sign

U/S

•Anechoic cyst adjacent to the posterior wall of the urinary bladder.

Cyst within cyst appearance

Dilated ureter terminating into the

ureterocele

Associated hydronephrosis

Associated

duplex kidney

Cyst within cyst appearance

Dilated ureter terminating into ureterocele

MSCT of ureterocele

Duplex system ureterocele

MRU

Bilateral ureteroceles