Ureterocele

Answer 1

Definition

A ureterocele is swelling in one of the tubes (ureters) that carry urine from the kidney to the bladder. The swelling can block urine flow.

A ureterocele is a birth defect.

Causes, incidence, and risk factors

A ureterocele occurs in the lower part of the ureter, where the tube enters the bladder. The swelling prevents urine from moving freely into the bladder. The urine collects in the ureter and stretches its walls, blowing it up like a water balloon.

Ureteroceles occur in about 1 in 500 to 1 in 4,000 people. Caucasians are most likely to be affected. Ureteroceles are equally common in left- and right-side ureters.

Symptoms

• Abdominal pain
• Back pain, possibly only on one side
• Blood in the urine
• Burning pain while urinating (dysuria)
• Fever
• Flank pain
  • On one side
  • May travel or radiate to the groin, genitals, thigh
  • Severe
  • Spasms
• Foul-smelling urine
• Frequent and urgent urination
• Lump (mass) in the abdomen that can be felt
• Ureterocele tissue falls down (prolapse) through the female urethra and into the vagina
• Urinary incontinence
• Urinary tract infection

Signs and tests

Large ureteroceles are usually diagnosed earlier than smaller ones. A ureterocele may be discovered before the baby is born (during a pregnancy ultrasound).

Some people with ureteroceles do not know they have the condition. Often, the diagnosis is made later in life due to kidney stones.

A urinalysis may reveal blood in the urine or signs of urinary tract infection.

The following tests may be performed:

• Abdominal ultrasound
• CT scan of the abdomen
• Cystoscopy
• Pyelogram
• Radionuclide renal scan
• Voiding cystourethrogram

Blood pressuremay be high if there is kidney damage.

Treatment

Antibiotics such as ampicillin or Bactrim are usually given to prevent further infections until surgery can be done.

The goal of treatment is to get rid of the blockage. Drains placed in the ureter or renal area (stents) may provide short-term relief of symptoms.

Surgery to repair the ureterocele usually cures the condition. Surgery involves making a cut into the ureterocele ("popping the water balloon") or removing the ureterocele and reattaching the ureter to the bladder. Which surgery is performed depends on the severity of the blockage.

Expectations (prognosis)

The outcome varies. If the obstruction can be cured, the damage may be temporary. However, damage to the kidney may be permanent, especially if the condition doesn't go away.

Kidney failure is uncommon because the other kidney usually continues to work as normal.

Complications

• Permanent bladder damage (incontinence/urinary retention)
• Permanent kidney damage, with a decrease or loss of function (one kidney)
• Urinary tract infection that keeps coming back

Calling your health care provider

Call your health care provider if you have symptoms of ureterocele.

References

Schlussel RN, Retik AB. Ectopic ureter, ureterocele, and other anomalies of the ureter. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 116.

Guay-Woodford LM. Hereditary nephropathies and abnormalities of the urinary tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 129.

Answer 2

Definition

A ureterocele is a swelling at the bottom of one of the tubes (ureters) that carry urine from the kidney to the bladder. The swollen area can block urine flow.

A ureterocele is a birth defect.

Causes, incidence, and risk factors

A ureterocele occurs in the lower part of the ureter, where the tube enters the bladder. The swollen area prevents urine from moving freely into the bladder. The urine collects in the ureter and stretches its walls, blowing it up like a water balloon.

A ureterocele can also cause urine to flow backward from the bladder to the kidney. This is called reflux.

Ureteroceles occur in about 1 in 500 to 1 in 4,000 people. Caucasians are most likely to be affected. Ureteroceles are equally common in left- and right-side ureters.

Symptoms

• Abdominal pain
• Back pain, possibly only on one side
• Blood in the urine
• Burning pain while urinating (dysuria)
• Fever
• Flank pain
  • On one side
  • May travel or radiate to the groin, genitals, thigh
  • Severe
  • Spasms
• Foul-smelling urine
• Frequent and urgent urination
• Lump (mass) in the abdomen that can be felt
• Ureterocele tissue falls down (prolapse) through the female urethra and into the vagina
• Urinary incontinence
• Urinary tract infection

Signs and tests

Large ureteroceles are usually diagnosed earlier than smaller ones. A ureterocele may be discovered before the baby is born (during a pregnancy ultrasound).

Some people with ureteroceles do not know they have the condition. Often, the diagnosis is made later in life due to kidney stones or infection.

A urinalysis may reveal blood in the urine or signs of urinary tract infection.

The following tests may be performed:

• Abdominal ultrasound
• CT scan of the abdomen
• Cystoscopy(examination of the inside of the bladder)
• Pyelogram
• Radionuclide renal scan
• Voiding cystourethrogram

Blood pressure may be high if there is kidney damage.

Treatment

Antibiotics are usually given to prevent further infections until surgery can be done.

The goal of treatment is to get rid of the blockage. Drains placed in the ureter or renal area (stents) may provide short-term relief of symptoms.

Surgery to repair the ureterocele usually cures the condition. Surgery involves making a cut into the ureterocele or removing the ureterocele and reattaching the ureter to the bladder. Which surgery is performed depends on the severity of the blockage.

Expectations (prognosis)

The outcome varies. If the obstruction can be cured, the damage may be temporary. However, damage to the kidney may be permanent, especially if the condition doesn't go away.

Kidney failure is uncommon because the other kidney usually continues to work as normal.

Complications

• Permanent bladder damage (incontinence/urinary retention)
• Permanent kidney damage, with a decrease or loss of function (one kidney)
• Urinary tract infection that keeps coming back

Calling your health care provider

Call your health care provider if you have symptoms of ureterocele.

References

Schlussel RN, Retik AB. Ectopic ureter, ureterocele, and other anomalies of the ureter. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 116.

Guay-Woodford LM. Hereditary nephropathies and abnormalities of the urinary tract. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 129.

Reviewed By

Review Date: 09/03/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.