A ureterocele is a cystic expansion or bulge near the opening of the ureter or ureter (which runs from the renal pelvis to the bladder) in the (urinary) bladder. Normally urine flows freely from the kidney to the bladder, but a ureterocele can partially or completely obstruct or disrupt the flow of urine, sometimes even causing urine to flow back to the affected kidney. But it also happens that a ureterocele does not cause any complaints or symptoms at all. A ureterocele is a congenital defect that affects girls more often than boys. It is diagnosed in childhood.
- What is a ureterocele?
- Causes
- Forms of ureterocele
- Orthotopic ureterocele
- Ectopic ureterocele
- Symptoms
- No symptoms
- Symptoms
- Description of the complaints
- Complications
- Examination and diagnosis
- Therapy
- Prognosis
- Prevention
Urinary tract / Source: La Gorda/Shutterstock.com
What is a ureterocele?
A ureterocele is a spherical enlargement of a part of the ureter or ureter near the opening of the ureter or ureter. A ureterocele is often associated with ureteral stenosis (narrowing) or vesicorenal reflux (the backflow of urine from the bladder to the kidneys), but can also remain asymptomatic. Basically, the part of the ureter that runs into the urinary bladder wall is affected. Swelling occurs at the bottom of one of the ureters. Ureteroceles can grow very large and under certain conditions fill the entire bladder and therefore potentially escape ultrasound detection. If such a large ureterocele compresses the opposing ureter, it can lead to bilateral pooling of urine, possibly with subsequent renal failure.
The ureterocele often has only a very small opening in the urinary bladder and, depending on how full it is, bulges into the bladder. This stenosis or narrowing causes a urinary outflow disorder; the ureter may meander or twist and expand like a bag throughout its course up to the kidney. Increases in pressure in the renal system damage kidney function and drainage disorders in the urinary tract are often the cause of a secondary or chronic urinary tract infection.
A ureterocele / Source: SCiardullo, Wikimedia Commons (CC BY-SA-3.0)
Causes
The exact cause of a ureterocele is unknown in 2023. As of 2023, no causal genetic factors have yet been found. Abnormalities in the mesonephric (urinary) tract (or: Wolff’s tract) can lead to ureterocele, which is often associated with ipsilateral renal agenesis (a kidney that has not developed properly or an atrophic kidney or shriveled kidney) and ipsilateral vesicle retention cyst seminalis (seminal vesicles). This condition is known as Zinner’s syndrome.
Forms of ureterocele
Depending on the position relative to the normal ureteral ostium (opening), a distinction is made between an ‘ectopic ureterocele’ and an ‘orthotopic ureterocele’.
Orthotopic ureterocele
In an orthotopic ureterocele, the ureterocele is limited to the urinary bladder. This form is less common.
Ectopic ureterocele
The more common ectopic ureterocele is associated with a ureter and the cystic distention extends into the bladder neck or urethral tract. In addition, in at least 50 percent of cases, this form of ureterocele exhibits vesicoureteral reflux (VUR), which means backflow of urine from the bladder to the kidneys.
Symptoms
No symptoms
Most ureteroceles are quite small and only minimally obstruct urine flow. These cases are asymptomatic and the child has no symptoms.
Symptoms
Larger ureteroceles can cause various complaints. The most common complaint is a urinary tract infection with symptoms such as:
- fever
- pain when urinating or burning sensation when urinating
- strong or foul urine odor
- sudden onset of frequent urination
- enuresis, or involuntary urination, usually during sleep
A large ureterocele can also cause one or more of the following symptoms in the child :
- a bulge in the abdominal area (if the ureterocele prevents urine from leaving the bladder)
- incontinence
- blood in the urine
- not being able to urinate
- difficulty urinating
- stomach ache
- pelvic pain
- recurrent urinary tract infections
Description of the complaints
With an orthotopic ureterocele, complaints only occur sporadically. However, in the case of an ectopic ureterocele, especially if they are somewhat larger, there are often symptoms in the sense of recurrent and treatment-resistant urinary tract infections. These can also spread to the kidneys and, for example, lead to inflammation of the kidneys (pyelonephritis). Affected children then suffer from typical symptoms of a urinary tract infection such as a burning sensation when urinating, diffuse abdominal pain, side pain, nausea, possible vomiting and loss of appetite. Depending on the severity, fever and hematuria (blood in the urine) may occur.
Complications
Possible complications of a ureterocele include:
- incontinence
- urinary retention
- chronic kidney disease (including loss of function in one kidney)
- recurring urinary tract infections
- kidney failure
- developing kidney stones
Examination and diagnosis
The doctor will ask questions about the complaints and perform a physical examination of the child. Follow-up research may consist of:
- ultrasound
- urography (taking an X-ray of the urinary tract after a fluid has been injected into the veins or urinary tract in order to visualize abnormalities)
- voiding cystourethrography (MCUG,
- X-ray contrast examination of the urethra and bladder during filling of the bladder and during urination)
Therapy
Depending on the renal function, the ureterocele is treated endoscopically. If the endoscopic procedure fails or if the symptoms return, open surgery is necessary. In that case, an extensive reconstruction with reimplantation of both ureters will take place and the part of the kidney that is no longer functional will be removed.
Prognosis
The prognosis varies. The problem can usually be corrected with a non-invasive treatment. Sometimes damage has already occurred, which is irreversible. Kidney failure occurs only rarely. The other kidney usually works properly.
Prevention
This is a birth defect that cannot be prevented, but can be treated.
read more
- Urinary tract infection: symptoms, causes and treatment
- Shredded kidney: symptoms, causes & treatment of kidney atrophy
- Blood in urine: macroscopic or microscopic hematuria
- Kidney Failure: Symptoms and Causes of Kidney Insufficiency
- Urethral stricture: symptoms & treatment of urethral stricture