URETEROCELE - A CASE REPORT

DIAGRAMMATIC REPRESENTATION OF URETEROCELE

IVP images

In the above case we can see that the right sided PCS appears duplicated. The ureter also appears duplicated in the upper portion.

The left sided kidney appears to be at a lower position and also shows clubbing of calyces with loss of papillary impressions and blunting of fornices which suggest gross hydronephrosis. Left sided ureter appears to be dilated throughout its course with kinking in the middle part. In the 3rd image the ureterocele is clearly seen within the bladder.

USG Correlation

On correlating with USG the above mentioned findings were confirmed.

The duplicated PCS can be appreciated in the RRight Kidney, Left kidney Hydroureteronephrosis is seen.

In the last image the typical appearance of the ureterocele can be appreciated.

CASE DISCUSSION

INTRODUCTION

Aureteroceleis a congenital abnormality found in theurinary bladder. In this condition calledureteroceles, thedistal ureterballoons at its opening into the bladder, forming a sac-like pouch. It is most often associated with a double collector system, where two ureters drain their respectivekidneyinstead of one

CLASSIFICATION

Intravesical

Confined within the bladder

Ectopic

Some part extends to the bladder neck or urethra

Stenotic

Intravesical ureterocele with a narrow opening

Sphincteric

Ectopic ureterocele with an orifice distal to the bladder neck

Sphincterostenotic

Orifice is both stenostic and distal to the bladder neck

Cecoureterocele

Ectopic ureterocele that extends into the urethra, but the orifice is in the bladder

SIGNS & SYMPTOMS

The signs and symptoms of ureteroceles in the latter two forms can easily be confused with other medical conditions.Symptomscan include:

• Frequenturinary tract infection


• Urosepsis


• Obstructive voiding symptoms


• Urinary retention


• Failure to thrive


• Hematuria


• Cyclicabdominal pain


• Ureteral calculus


• cobra head sign is seen in radiography.

COMPLICATIONS

Many other complications arise from ureteroceles. Redundant collection systems are usually smaller in diameter than single, and predispose the patient to impassablekidney stones. The effective "bladder within a bladder" compounds this problem by increasing the collision ofuric acid particles, the process by which uric acid stones are formed. Ureteroceles is also associated with poor kidney function. It can cause frequent blockage of the ureter leading to serious kidney damage. In other cases, a small, upper portion of the kidney is congenitally non-functional. Though often benign, this problem can necessitate the removal of non-functioning parts.

RADIOLOGIC EVALUATION & ITS LIMITATIONS

Radiologic evaluation of a ureterocele in an adult usually includes a kidney-bladder ultrasonography. Ultrasonography can be the initial study performed, and it can be used to detect prenatal ureteroceles. Ultrasonography noninvasively depicts anatomic changes in the kidney and bladder. Sonography should be performed with the bladder empty and with it filled to eliminate nonvisualization of ureteroceles due to either compression of the bladder or the ureterocele. Ultrasonography is the most sensitive test and often the only radiologic evaluation required for the diagnosis of ureteroceles.

Functional studies of the renal system include intravenous pyelography, CT scanning, and renal scanning. These contrast-enhanced studies help delineate the relevant renal anatomy, especially with regard to potential renal duplications. They are also useful in evaluating the differential renal function. Contrast-enhanced studies help identify ureteroceles within the bladder as a thin nonenhancing rim around contrast enhancement within the ureterocele. These functional studies often add supplemental information that is useful in the treatment of patients with ureteroceles, but they are typically not used as first-line imaging modalities for the diagnosis of suspected ureteroceles.

LIMITATIONS

Ultrasonography is the most sensitive test for the detection of ureteroceles. Ultrasonography may cause ureteroceles to be missed if the patient’s bladder is empty or fully distended, if the ureteroceles are small, or if the patient’s body habitus precludes proper examination. Ultrasonographic findings are relatively specific for ureteroceles because the other etiologies of a cyst within a cyst are relatively rare.

CT scans, intravenous pyelograms, and renal scans are less sensitive for ureteroceles, but they help to more clearly delineate the functional anatomy of the kidneys.