Ureterocele
Encyclopedia
A ureterocele is a congenital abnormality found in the urinary bladder
. In this condition called ureteroceles, the distal ureter
balloons at its opening into the bladder, forming a sac-like pouch. It is most often associated with a duplicated collection system, where two ureters drain their respective kidney
instead of one. Simple ureteroceles, where the condition involves only a single ureter, represents only twenty percent of cases. Ureteroceles affects one in 4,000 individuals, at least four fifths of whom are female. Patients are frequently Caucasian.
Since the advent of the ultrasound
, most ureteroceles are diagnosed prenatally. The pediatric and adult conditions are often found only through diagnostic imaging performed for reasons other than suspicious ureteroceles.
s can include:
, 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.
, it has not been substantiated that genetics
are to blame.
Treatment
· Single-system ureterocele Initial management is usually endoscopic incision of the ureterocele, which can be followed by surgical ureteric re-implantation to preserve renal function and prevent reflux.
· Duplex-system ureterocele Treatment options vary with the individual and include: endoscopic incision; upper pole nephrectomy for a poorly functioning unit with ureterectomy or, where there is useful renal function, ureteropyelostomy can be performed.
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
. In this condition called ureteroceles, the distal ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....
balloons at its opening into the bladder, forming a sac-like pouch. It is most often associated with a duplicated collection system, where two ureters drain their respective kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
instead of one. Simple ureteroceles, where the condition involves only a single ureter, represents only twenty percent of cases. Ureteroceles affects one in 4,000 individuals, at least four fifths of whom are female. Patients are frequently Caucasian.
Since the advent of the ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
, most ureteroceles are diagnosed prenatally. The pediatric and adult conditions are often found only through diagnostic imaging performed for reasons other than suspicious ureteroceles.
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 and symptoms
The signs and symptoms of ureteroceles in the latter two forms can easily be confused with other medical conditions. SymptomSymptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s can include:
- Frequent urinary tract infectionUrinary tract infectionA urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
- Urosepsis
- Obstructive voiding symptoms
- Urinary retentionUrinary retentionUrinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
- Failure to thriveFailure to thriveFailure to thrive is a medical term which is used in both pediatric and adult human medicine, as well as veterinary medicine ....
- HematuriaHematuriaIn medicine, hematuria, or haematuria, is the presence of red blood cells in the urine. It may be idiopathic and/or benign, or it can be a sign that there is a kidney stone or a tumor in the urinary tract , ranging from trivial to lethal...
- Cyclic abdominal painAbdominal painAbdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
- 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 impassable kidney stones. The effective "bladder within a bladder" compounds this problem by increasing the collision of uric acid particlesUric acid
Uric acid is a heterocyclic compound of carbon, nitrogen, oxygen, and hydrogen with the formula C5H4N4O3. It forms ions and salts known as urates and acid urates such as ammonium acid urate. Uric acid is created when the body breaks down purine nucleotides. High blood concentrations of uric acid...
, 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.
Causes
Definitive causes of ureteroceles have not been found. While the abnormal growth occurs within the uterusUterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
, it has not been substantiated that genetics
Genetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
are to blame.
Treatment
· Single-system ureterocele Initial management is usually endoscopic incision of the ureterocele, which can be followed by surgical ureteric re-implantation to preserve renal function and prevent reflux.
· Duplex-system ureterocele Treatment options vary with the individual and include: endoscopic incision; upper pole nephrectomy for a poorly functioning unit with ureterectomy or, where there is useful renal function, ureteropyelostomy can be performed.