Ureterocele
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Transcript of Ureterocele
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