eMedicine Specialties > Radiology > Genitourinary

Ureterocele: Follow-up

Author: Ganesh Raj, MD, PhD, Staff Physician, Department of Surgery, Division of Urology, Duke University Medical Center
Coauthor(s): John S Wiener, MD, FACS, FAAP, Chief, Division of Urology, Professor, Department of Surgery, Division of Urology, Professor, Department of Pediatrics, University of Mississippi Medical Center; Richard A Leder, MD, Department of Radiology, Associate Clinical Professor, Division of Abdominal Imaging, Duke University School of Medicine
Contributor Information and Disclosures

Updated: Sep 21, 2007

Intervention

Each patient with a ureterocele is clinically unique regarding anatomy, pathophysiology, and renal function. As such, treatment options must be individualized. Treatment often involves surgical intervention. Prior to surgical intervention, the anatomy of the urinary tract must be delineated as clearly as possible. Ipsilateral and contralateral renal function must be assessed, and treatment should be initiated expeditiously. The 4 goals of intervention include (1) control and elimination of infection, (2) minimization of vesicoureteral reflux and bladder outlet obstruction, (3) preservation of urinary continence mechanisms, and (4) protection of renal function.

In infants with symptomatic ureteroceles, antibiotics should be administered to treat urinary tract infections. Antibiotic prophylaxis is associated with a low incidence of urinary tract infections, and it may be used to delay surgical intervention until the bladder matures. Small asymptomatic ureteroceles may be observed with careful serial physical and ultrasonographic examinations.

Surgical options include endoscopic ureterocele incision and—depending on renal function—percutaneous diversion, ureteropyelostomy, partial or total nephroureterectomy, and complete reconstruction.

In the endoscopic approach, a small endoscopic incision is made inferiorly and medially on the anterior wall of the ureterocele above its base at the bladder neck. This minimally invasive method is associated with low morbidity rates and represents an effective method of decompression in infants. The endoscopic approach is highly successful for small, single-system intravesical ureteroceles. With this procedure, the reported incidence of iatrogenic reflux and incontinence (<10%) is low, and secondary procedures are often not needed (10-15%). The endoscopic approach represents a good first-line method for the acute management of symptomatic ureteroceles.

Radiologic interventions for ureteroceles are primarily temporizing maneuvers rather than definitive procedures. Percutaneous nephrostomy drainage allows decompression of a dilated renal pelvis prior to definitive treatment of the ureterocele.

Medicolegal Pitfalls

• The failure to diagnose and treat ureteroceles appropriately may result in progressive hydronephrosis, renal scarring, and eventual renal failure.
• The failure to diagnose ureteroceles occurs primarily because of a lack of suspicion by clinicians and, occasionally, because of an inadequate radiologic workup. Unusual presentations, including acute or recurrent urinary infections, abdominal masses, continuous dampness, epididymo-orchitis, and pelvic pain syndromes, should be evaluated for ureteroceles in the absence of other etiologies. Prolapsed ureteroceles that appear as a mass at the vaginal introitus should be carefully evaluated.
• Treatment for ureteroceles should be individualized, given that a number of therapeutic options are available. The contralateral system should always be assessed adequately. Treatment of ureteroceles with aggressive unroofing of ureteroceles converts an obstructed system to a freely refluxing system; this should be avoided.

• Search for CME/CE on This Topic »

• Ureterocele (Urology)
• Ureteral Duplication, Ureteral Ectopia, and Ureterocele (Pediatrics: Surgery)
• Pyonephrosis (Urology)
• Genital Anomalies (Pediatrics: Surgery)