- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
A ureterocele is a cystic dilatation of the terminal ureter within the bladder and/or the urethra (figure 1). It may present as an incidental finding on antenatal ultrasonography, or postnatally because of symptoms due to urinary tract infection (UTI) or obstruction.
Ureterocele, including its pathophysiology, clinical presentation, diagnosis, evaluation, and management will be reviewed here.
At autopsy, the incidence of ureteroceles has been reported as 1 in 500 cases . Ureteroceles occur four to six times more frequently in females than in males, and more commonly in Caucasians than in other races . Unilateral ureteroceles occur with similar frequency on the right and left, and in 10 percent of cases there is bilateral involvement.
The classification system adopted by the Section on Urology of the American Academy of Pediatrics divides ureteroceles based on their location . According to this system, ureteroceles are classified as intravesical (ie, entirely within the bladder) or ectopic (ie, a portion extends beyond the bladder neck into the urethra) (figure 1). At times, differentiating between intravesical and ectopic ureteroceles may be difficult. Historically, ectopic ureteroceles that inserted beyond the bladder neck into the urethra were called cecoureteroceles.
Ureteroceles also may be classified depending upon whether they are associated with either a single collecting system (ie, single ureter and kidney) or a double collecting (duplex) system (complete ureteral duplication). Approximately 80 percent of ureteroceles are associated with the upper pole of a duplex collecting system, and 60 percent of these are ectopic , whereas intravesical ureteroceles are more common in single systems.
- USON AC, LATTIMER JK, MELICOW MM. Ureteroceles in infants and children: a report based on 44 cases. Pediatrics 1961; 27:971.
- Shokeir AA, Nijman RJ. Ureterocele: an ongoing challenge in infancy and childhood. BJU Int 2002; 90:777.
- Glassberg KI, Braren V, Duckett JW, et al. Suggested terminology for duplex systems, ectopic ureters and ureteroceles. J Urol 1984; 132:1153.
- Coplen DE, Duckett JW. The modern approach to ureteroceles. J Urol 1995; 153:166.
- Geringer AM, Berdon WE, Seldin DW, Hensle TW. The diagnostic approach to ectopic ureterocele and the renal duplication complex. J Urol 1983; 129:539.
- Jesus LE, Farhat WA, Amarante AC, et al. Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles. J Urol 2011; 186:1455.
- Shankar KR, Vishwanath N, Rickwood AM. Outcome of patients with prenatally detected duplex system ureterocele; natural history of those managed expectantly. J Urol 2001; 165:1226.
- Rickwood AM, Reiner I, Jones M, Pournaras C. Current management of duplex-system ureteroceles: experience with 41 patients. Br J Urol 1992; 70:196.
- Jayanthi VR, Koff SA. Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems. J Urol 1999; 162:1077.
- Coplen DE. Neonatal ureterocele incision. J Urol 1998; 159:1010.
- Byun E, Merguerian PA. A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. J Urol 2006; 176:1871.
- Cooper CS, Passerini-Glazel G, Hutcheson JC, et al. Long-term followup of endoscopic incision of ureteroceles: intravesical versus extravesical. J Urol 2000; 164:1097.
- Husmann DA, Strand WR, Ewalt DH, Kramer SA. Is endoscopic decompression of the neonatal extravesical upper pole ureterocele necessary for prevention of urinary tract infections or bladder neck obstruction? J Urol 2002; 167:1440.
- DeFoor W, Minevich E, Tackett L, et al. Ectopic ureterocele: clinical application of classification based on renal unit jeopardy. J Urol 2003; 169:1092.
- Hagg MJ, Mourachov PV, Snyder HM, et al. The modern endoscopic approach to ureterocele. J Urol 2000; 163:940.
- Upadhyay J, Bolduc S, Braga L, et al. Impact of prenatal diagnosis on the morbidity associated with ureterocele management. J Urol 2002; 167:2560.
- Beganović A, Klijn AJ, Dik P, De Jong TP. Ectopic ureterocele: long-term results of open surgical therapy in 54 patients. J Urol 2007; 178:251.
- CLINICAL PRESENTATION
- DIAGNOSIS AND EVALUATION
- Voiding cystourethrogram
- - Intravesical versus ectopic
- - Duplex system
- - Single system
- - Age at presentation
- - Reflux
- Our approach
- SUMMARY AND RECOMMENDATIONS