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Ureterocele

Most of us are born with two ureters, one from each kidney to drain the urine into the bladder. Yet what if the portion of the ureter closest to the bladder becomes enlarged because the ureter opening is very tiny and obstructs urine outflow? That is the case for people with a ureterocele. Luckily, medicine has given urologists a range of diagnostic tests and surgical techniques to deal with this abnormality. So read below to see how your urologist might correct this condition.

What happens under normal conditions?

Within the urinary tract, the kidneys filter and remove waste and water from the blood to produce urine. The urine travels from the kidneys down narrow tubes called the ureters, where it is then stored in the bladder. Normally, the attachment between the ureters and the bladder is a one-way flap valve that allows unimpeded urinary flow into the bladder but prevents urine from flowing backward (when urine flows backwards from the bladder it is called vesicoureteral reflux) into the kidneys. Approximately one out of 125 people may have two ureters draining a single kidney. One ureter drains the upper part of the kidney and the second ureter drains the lower portion. This "duplicated collecting system" is not a problem as long as each ureter enters the bladder normally. When the bladder empties, urine flows out of the body through the urethra, a tube at the bottom of the bladder. The opening of the urethra is at the end of the penis in boys and in front of the vagina in girls.

What is a ureterocele?

A ureterocele is a birth defect that affects the kidney, ureter and bladder. When a person has a ureterocele, the portion of the ureter closest to the bladder swells up like a balloon because the ureteral opening is very tiny and obstructs urine outflow. As the urine flow is obstructed, urine backs up in the ureter. Approximately 1 in 500 to 1 in 4,000 individuals are affected by this condition. In 90 percent of girls the ureterocele occurs in the upper half of a duplicated urinary tract (two ureters draining from one kidney). Approximately half of boys have a duplicated urinary tract and half have a single system. Ureterocele may be "ectopic" when a portion protrudes through the bladder outlet into the urethra, or "orthotopic" when they remain entirely within the bladder. In 5 to 10 percent of cases there is an ureterocele on both sides (bilateral). The majority of ureteroceles are diagnosed in children less than two years of age, although occasionally older children or adults are found to have an ureterocele.

What are some complications of a ureterocele?

This condition often predisposes an individual to a kidney infection. Vesicoureteral reflux is also common, particularly in individuals with a duplication of the urinary tract, because the ureterocele distorts the normal one-way valve attachment between the ureter and bladder. In addition, reflux into the opposite kidney is common for similar reasons. In rare cases, an ureterocele may prevent the passage of kidney stones. Also, the ureterocele may be so large that it completely obstructs the flow of urine from the bladder into the urethra. Occasionally, in girls, the ureterocele may sink and protrude all the way out from the opening of the urethra.

What are some symptoms of a ureterocele?

Usually a ureterocele has no symptoms. However, patients can have flank or back pain, urinary tract infection, fever, painful urination, foul-smelling urine, abdominal pain, blood in the urine (hematuria) and/or excessive urination.

How is a ureterocele diagnosed?

Usually doctors detect ureteroceles during maternal ultrasounds performed before birth, but they may not be diagnosed until a patient is being evaluated for another medical condition like a urinary tract infection.

Ultrasonography is the first imaging test used in evaluation. Additional imaging studies may also be necessary to help delineate the anatomy. One such test is a voiding cystourethrogram (VCUG), which is an X-ray examination of the bladder and lower urinary tract. A catheter is inserted through the urethra, the bladder is filled with a water-soluble contrast and then the catheter is withdrawn. Several X-ray images of the bladder and urethra are captured as the patient empties the bladder. These images allow radiologists to diagnose any abnormalities in the flow of urine through the body.

In individuals with an ureterocele, it is also important to evaluate the function of the kidneys, specifically to determine whether the affected portion of the kidney has any function. In most cases, this evaluation is performed with a renal scan.

Abdominal CT scans and MRI tests are additional studies that may also be performed in the evaluation of a patient with an ureterocele. These tests are usually performed in situations where the urinary tract anatomy is extremely ambiguous and will allow the surgeon to better identify anatomical variations.

What are some treatment options?

The timing and type of treatment are based on the age of the patient, whether the affected portion of the kidney is functioning and whether vesicoureteral reflux is present. In some cases, more than one procedure is necessary. In rare cases, observation (no treatment) may be recommended.

Because a ureterocele predisposes an individual to a kidney infection, usually an antibiotic is prescribed until the ureterocele and its complicating features have been treated. The following are available treatment options:

Transurethral puncture: A form of minimally invasive therapy is to puncture and decompress the ureterocele using a cystoscope that is inserted through the urethra. The procedure usually takes 15 to 30 minutes, and often can be done on an outpatient basis. In some cases, this treatment is unsuccessful if the ureterocele wall is thick and difficult to recognize. The advantage of this treatment is that there is no surgical incision. Risks include failure to adequately decompress the ureterocele, possibly causing urine to flow into the ureterocele, which could necessitate an open operation. In addition, there is a slight risk of causing an obstructive flap valve with the ureterocele, which can make it difficult to urinate. This treatment is best suited for ureteroceles entirely within the bladder (orthotopic) than for those that extend beyond the bladder, in which case it can be helpful, but is rarely the only treatment needed.

Upper pole nephrectomy: Often, if the upper half of the kidney does not function because of the ureterocele and there is no vesicoureteral reflux, removal of the affected portion of the kidney is recommended. In many cases, this operation is performed through a small incision under the rib cage. In more and more cases it may be performed laparoscopically.

Nephrectomy: If the entire kidney does not function because of the ureterocele, removal of the kidney is recommended. Usually this can be done laparoscopically, although at some centers it is performed through a very small incision under the rib cage.

Removal of the ureterocele and ureteral reimplantation: If it is deemed necessary to remove the ureterocele, then an operation is performed in which the bladder is opened, the ureterocele is removed, the floor of the bladder and bladder neck are reconstructed and the ureters are reimplanted in such a way to create a non-refluxing connection between the ureters and the bladder. The operation is performed through a small lower abdominal incision. The success rate with this procedure is 90 to 95 percent. Complications include vesicoureteral reflux or obstruction.

Ureteropyelostomy or upper-to-lower ureteroureterostomy: If the upper portion of the ureter shows significant function, one option is to connect the obstructed upper portion to the non-obstructed lower portion of the ureter or pelvis of the kidney. The operation is done through a small lower abdominal incision. The success rate with this procedure is 95 percent.

Frequently asked questions:

Is there any way to prevent this condition?

There is no known prevention for this condition; it is present at birth but may not be discovered until later in life.

My baby was diagnosed with an ureterocele on a prenatal ultrasound. She seems very healthy. Is it absolutely necessary for her to undergo treatment?

In the past, most children with an ureterocele had their condition detected following a serious kidney infection, which often required hospitalization for intravenous antibiotics. Consequently, it would be unusual for her not to develop a urinary tract infection unless her ureterocele was treated.

My doctor has recommended that my daughter take antibiotic prophylaxis because she has an ureterocele and urinary reflux. Is it safe to take antibiotics every day?

Many children and adults take a low dose of an antibiotic every day to prevent urinary tract infections. This form of therapy has been used for over 35 years and has proven to be relatively safe, as long as the dose is maintained at one-fourth to one-half the full dose. Although we recognize that using antibiotics has some downsides, one needs to weigh the risk of taking the antibiotic against the risk of a serious kidney infection if the antibiotic were not taken.

My child was diagnosed with an ureterocele and it was punctured through a small scope. Now there is reflux into the ureterocele and the lower part of the kidney also. Will more surgery be necessary?

In most cases, if there is reflux up the ureter into the lower part of the kidney and/or the ureterocele, the reflux is unlikely to disappear with time and removal of the ureterocele and ureteral reimplantation is often necessary.



Reviewed: January 2011

Last updated: March 2013

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Ureterocele Glossary
  • abdominal: in the abdomen, the cavity of this part of the body containing the stomach, intestines and bladder.

  • abnormality: A variation from a normal structure or function of the body.

  • anatomy: The physical structure of an internal structure of an organism or any of its parts.

  • antibiotic: Drug that kills bacteria or prevents them from multiplying.

  • antibiotic prophylaxis: Daily treatment with antibiotics to prevent infection.

  • bilateral: Term describing a condition that affects both sides of the body or two paired organs.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • bladder neck: Area of thickened muscle fiber where the bladder joins the urethra. Acting on signals from the brain, bladder neck muscles can either tighten to hold urine in the bladder or relax to allow urine out and into the urethra. These muscles also tighten during ejaculation to prevent backflow of semen into the bladder.

  • catheter: A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.

  • CT scan: Also known as computerized tomography, computerized axial tomography or CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images of the body. Shows detailed images of any part of the body, including bones, muscles, fat and organs. CT scans are more detailed than general X-rays.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cystoscope: A narrow, tube-like instrument fitted with lenses and a light passed through the urethra to look inside the bladder. The procedure is called cystoscopy (sis-TAW-skuh-pee).

  • cystourethrogram: Also called a voiding cystogram. A specific X-ray that examines the urinary tract. A catheter (hollows tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body)and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The X-rays will show if there is any reverse flow of urine into the ureters and kidneys.

  • ectopic: Used to describe an organ or body part occurring in a position or form that is not usual.

  • flank: The area on the side of the body between the rib and hip.

  • hematuria: Blood in the urine, which can be a sign of a kidney stone or other urinary problem. Gross hematuria is blood that is visible to the naked eye. Microscopic hematuria cannot be seen but is detected on a urine test.

  • incision: Surgical cut for entering the body to perform an operation.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • intravenous: Also referred to as IV. Existing or occurring inside a vein.

  • invasive: Having or showing a tendency to spread from the point of origin to adjacent tissue, as some cancers do. Involving cutting or puncturing the skin or inserting instruments into the body.

  • invasive: Not just on the surface; with regard to bladder cancer, a tumor that has grown into the bladder wall.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • kidney infection: Also called pyelonephritis. Urinary tract infection involving the kidney. Typical symptoms include abdominal or back pain, fever, malaise and nausea or vomiting.

  • kidney stone: A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis or in the ureters. (Also see nephrolithiasis.)

  • kidneys: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • laparoscopic: Using an instrument in the shape of a tube that is inserted through the abdominal wall to give an examining doctor a view of the internal organs.

  • laparoscopically: With the use of a laparoscope, an instrument in the shape of a tube that is inserted through the abdominal wall to give an examining doctor a view of the internal organs.

  • MRI: Also referred to a magnetic resonance imaging. A diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body.

  • nephrectomy: Surgical removal of a kidney.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • orthotopic: In the normal or usual position.

  • ostomy: A surgical procedure such as a colostomy or ileostomy, in which an artificial opening for excreting waste matter is created.

  • pelvis: The bowl-shaped bone that supports the spine and holds up the digestive, urinary and reproductive organs. The legs connect to the body at the pelvis.

  • penis: The male organ used for urination and sex.

  • prenatal: Before birth.

  • radiologist: Doctor specializing in the interpretation of X-rays and other scanning techniques for the diagnosis of disorders.

  • reflux: Backward flow of urine. Also referred to as vesicoureteral reflux (VUR). An abnormal condition in which urine backs up from the bladder into the ureters and occasionally into the kidneys, raising the risk of infection.

  • reflux: Backward flow.

  • renal: Pertaining to the kidneys.

  • renal scan: A nuclear medicine examination that uses small amounts of radioactive materials to measure the function of the kidneys.

  • soluble: Able to be dissolved in another substance like water.

  • stone: Small hard mass of mineral material formed in an organ.

  • ultrasound: Also referred to as a sonogram. A technique that bounces painless sound waves off organs to create an image of their structure to detect abnormalities.

  • ureter: One of two tubes that carry urine from the kidneys to the bladder.

  • ureteral: Pertaining to the ureter. Also referred to as ureteric.

  • ureteral reimplantation: Surgery to create a new, longer tunnel for the ureter to pass through the bladder wall.

  • ureterocele: The portion of the ureter closest to the bladder becomes swollen because the ureter opening is very tiny and obstructs urine outflow; urine backs up in the ureter tube.

  • ureterostomy: Establishment of an external opening into the ureter.

  • ureteroureterostomy: Establishment of an anastomosis (an opening created from surgery, trauma or disease) between the two ureters or between two segments of the same ureter.

  • ureters: Pair of tubes that carry urine from each kidney to the bladder.

  • ureters: Tubes that carry urine from the kidneys to the bladder.

  • urethra: A tube that carries urine from the bladder to the outside of the body. In males, the urethra serves as the channel through which semen is ejaculated and it extends from the bladder to the tip of the penis. In females, the urethra is much shorter than in males.

  • urethral: Relating to the urethra, the tube tha carries urine from the bladder to outside the body.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urinary tract infection: Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.

  • urinate: To release urine from the bladder to the outside. Also referred to as void.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urologist: A doctor who specializes in diseases of the male and female urinary systems and the male reproductive system. Click here to learn more about urologists. (Download the free Acrobat reader.)

  • urology: Branch of medicine concerned with the urinary tract in males and females and with the genital tract and reproductive system of males.

  • vagina: The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • VCUG: Also referred to as voiding cystourethrogram or voiding cystogram. A catheter is placed in the urethra and the bladder is filled with a contrast dye. X-ray images are taken as the bladder fills and empties to show any blockage or reverse urine flow.

  • vesicoureteral reflux: Also referred to as VUR. An abnormal condition in which urine backs up from the bladder into the ureters and occasionally into the kidneys, raising the risk of infection.

  • void: To urinate, empty the bladder.

  • voiding: Urinating.

  • voiding cystourethrogram: Also referred to as VCUG or voiding cystogram. A specific X-ray that examines the urinary tract. A catheter (hollows tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body)and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The X-rays will show if there is any reverse flow of urine into the ureters and kidneys.

Ureterocele Anatomical Drawings

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