Ureterocele Clinical Presentation

Updated: Feb 07, 2020
  • Author: Christopher S Cooper, MD, FACS, FAAP; Chief Editor: Edward David Kim, MD, FACS  more...
  • Print
Presentation

History

Currently, most pediatric ureteroceles are found during routine prenatal screening. Adult ureteroceles may also be found incidentally during imaging studies, often obtained for complaints of unrelated symptomatology. Ureteroceles frequently do not have clinical sequelae in the adult population. However, when problems arise, presenting clinical features of ureteroceles may include the following:

  • Urinary tract infection (UTI)
  • Urosepsis
  • Obstructive voiding symptoms
  • Urinary retention
  • Failure to thrive
  • Hematuria
  • Cyclic abdominal pain
  • Ureteral calculus

Pathologic ureteroceles most often affect the pediatric population. In young infants, failure to thrive or urinary tract infection may be the first sign of a symptomatic ureterocele.

Complications of ureteroceles in both pediatric and adult populations occur because of the obstructive nature of the ureterocele and its anatomic location. Because of the distal ureteral obstruction, the ipsilateral renal moiety is often hydronephrotic or dysplastic. The degree of hydronephrosis may wax and wane depending on the amount of urine produced by the renal moiety. Cyclical expansion and decompression of the renal pelvis manifests as intermittent abdominal pain in older children and adults.

In the setting of untreated UTIs and hydronephrosis, affected older children and adults may reveal signs and symptoms of pyonephrosis or frank urosepsis. The dilated ureterocele may cause urinary stasis and is a risk factor for ureteral stone formation within the saccular cavity. When distal ureteral stones develop, they cannot pass spontaneously because of the obstructing ureterocele orifice. Presence of stones within a ureterocele is exclusive to the adult population. A prolapsing ureterocele in a female patient may cause physical obstruction of the bladder neck. Anatomic obstruction of the bladder neck by the cystic ureterocele may incite obstructive voiding symptoms or may precipitate acute urinary retention in both pediatric and adult populations. Intravesical ureterocele has also been reported to cause bladder outlet obstruction in an adult male. [4]

Next:

Physical Examination

During the physical examination, particular attention should be paid to the abdomen and the genitalia. This is true for both pediatric and adult populations. Symptomatic ureteroceles with hydronephrosis may manifest as abdominal tenderness to palpation. An abdominal mass due to a large hydronephrotic kidney may be appreciated in the upper abdominal quadrant in thin adults and young children. Flank tenderness often accompanies the abdominal findings. In infants, an abdominal mass due to hydronephrosis may be noted by transillumination in a dark room.

During a female genital examination, a prolapsing cystic mass may be seen emerging from the external meatus. This is a sign of a prolapsing ureterocele. However, the differential diagnoses of a prolapsing mass in children should also include urethral prolapse, sarcoma botryoides, and urethral caruncle. Prolapsing ureteroceles can also occur in boys, but they are much less common. Duplex systems are more likely to cause urethral obstruction in males, although they occasionally can occur with just a single system. A minority of ureteroceles are discovered incidentally during ureteral reimplantation for vesicoureteral reflux.

Previous