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Ureterocele

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The Ureter

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Abstract

Almost 1% of human infants are born with urogenital abnormalities, many of which are linked to irregular connections between the distal ureters and the bladder. Ureterocele is an abnormal intravesical dilatation of the terminal ureter. In the past, most cases were detected postnatally when the child presented with urinary tract infections or urine dribbling. Ureteroceles may present both diagnostic and treatment challenges among urologists and pediatric surgeons. The diagnosis of ureterocele may be obvious in some cases, but at times, it is less clear and is then only diagnosed with a high index of suspicion and contingent on special investigations. The management of ureterocele varies according to its effects on obstruction, reflux, continence, and renal function. Therefore, it is imperative for the urologists to be aware of the variable clinical and radiological presentations and treatment options to yield the best possible results. Recently; with availability of ultrasound facilities allover the world, most cases of ureteroceles are diagnosed antenatally, but only limited centers can afford antenatal or early postnatal management. The treatment needs to be tailored for each case; depending on other factors such as the location of ureterocele, the age of the child, presence of a duplex or single system, the function of the kidney or the moiety, and the status of vesicoureteral reflux.

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Abbreviations

AHN:

Antenatal hydronephrosis

BOO:

Bladder Outlet Obstruction

CAP:

Continuous Antibiotic Prophylaxis

CECT:

Contrast-enhanced computed tomography

CND:

Common Nephric Duct

CT:

Computerized tomography

IVP:

Intravenous pyelogram

PUJ:

Pelviureteric junction

URL:

Ureteroscope lithotripsy

USS:

Ultrasound

UTIs:

Urinary tract infections

VCUG:

voiding cystourethrography

VUR:

Vesicoureteric Reflux

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Author information

Authors and Affiliations

  1. Pediatric Surgery, Al-Azhar University, Cairo, Egypt

    Mohamed A. Baky Fahmy

Authors
  1. Mohamed A. Baky Fahmy
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Editor information

Editors and Affiliations

  1. Belqas, Elnagar Urology Center, Mansoura City, Egypt

    Mahmoud Abdel-Gawad

  2. Urology Department, Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Bedeir Ali-El-Dein

  3. Department of Urology and Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    John Barry

  4. Department of Urology, Universitatsklinikum Tubingen, Tübingen, Baden-Württemberg, Germany

    Arnulf Stenzl

Questions

Questions

  1. 1.

    The Chwalla’s membrane:

    1. (a)

      Is a doubled layered ureterovesical membrane

    2. (b)

      Temporarily obstruct the ureterovesical region

    3. (c)

      Appear between the 37th and 43th days after conception

    4. (d)

      Divided the Wolffian duct from the urogenital sinus

    5. (e)

      All of the above

    Answer: (e)

  2. 2.

    The length of this intramural part of the ureter is:

    1. (a)

      In adults it is 3–5 cm

    2. (b)

      In neonates it is 0.5–0.8 cm

    3. (c)

      In adults it is 7 cm

    4. (d)

      In children it is about 4 cm

    5. (e)

      It is always variable

    Answer: (b)

  3. 3.

    The incidence of ureterocele:

    1. (a)

      At autopsy it is 1:500

    2. (b)

      Affecting Africans than other ethnic groups

    3. (c)

      Affecting man than women

    4. (d)

      Most cases reported at older age

    5. (e)

      All of the above

    Answer: (a)

  4. 4.

    The management of ureterocele varies according to:

    1. (a)

      The location of ureterocele

    2. (b)

      Presence of a duplex or single system

    3. (c)

      The function of the kidney

    4. (d)

      The function of the moiety

    5. (e)

      All of the above

    Answer: (e)

  5. 5.

    Ureterocele subtypes:

    1. (a)

      Intravesical cases represent about 80% of the cases.

    2. (b)

      Extravesical (or ectopic) represent 20% of the cases.

    3. (c)

      When it extends to the bladder neck or urethra it tends to occur with duplex systems.

    4. (d)

      Sphincteric: ureterocele extends into bladder neck, but it will not never extend to the urethra.

    5. (e)

      The orifice is usually wide and usually opens distal to the external sphincter.

    Answer: (c)

  6. 6.

    Ureterocele subtypes:

    1. (a)

      In males the sphincteric subtype usually presented with urinary retention.

    2. (b)

      In cecoureterocele subtype the ureterocele prolapses anterior to the urethra in male

    3. (c)

      Cecoureterocele is usually posterior to the vagina

    4. (d)

      The orifice of cecoureterocele is outside the bladder.

    5. (e)

      This type can cause urethral obstruction.

    Answer: (a)

  7. 7.

    Associated anomalies:

    1. (a)

      Thirty percent of ureteroceles occur in duplex system

    2. (b)

      Duplex system is not a common congenital malformations of urogenital system

    3. (c)

      Duplex system had an overall incidence of approximately 1–3%.

    4. (d)

      Duplex system was classified as complete or incomplete according to its relation with the kidney.

    5. (e)

      In Duplex anomaly the renal vessels, collecting system and ureter of duplex kidneys are not separated.

    Answer: (c)

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Baky Fahmy, M.A. (2023). Ureterocele. In: Abdel-Gawad, M., Ali-El-Dein, B., Barry, J., Stenzl, A. (eds) The Ureter . Springer, Cham. https://doi.org/10.1007/978-3-031-36212-5_5

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  • DOI: https://doi.org/10.1007/978-3-031-36212-5_5

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  • Online ISBN: 978-3-031-36212-5

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