Ureterocele

What is Ureterocele

Ureterocele is an abnormal swelling at the end of a ureter, near the bladder. Ureters are tubes that connect the kidneys to the bladder. After urine is filtered by the kidneys, it flows through the ureters to be stored in the bladder.

A ureterocele is a condition that your child is born with (congenital anomaly). Children with this condition usually have an extra ureter on one side of the body, which is likely to form a ureterocele.

Ureterocele is literally dilation of the ureter. If the ureter is ectopic, it is referred to as an ectopic ureterocele, and it will be well demonstrated on a CTU or MRU.

Another type of ureterocele is referred to as an orthotopic ureterocele. Here, there is congenital narrowing of the ureteral orifice at the ureterovesical junction (UVJ).

This causes dilation of the ureter in its course through the bladder wall, giving a “cobra-head” appearance to the dilated ureter. The walls of the ureterocele appear smooth and thin on imaging studies.

A pseudo-ureterocele is due to a stone or a tumor at the UVJ or adjacent bladder, which causes distal ureteral obstruction.

There is irregularity of the UVJ due to the edema caused by these processes, so that the walls of the dilated ureter may appear irregular or thickened rather than smooth and thin as with an orthotopic ureterocele.

A ureterocele usually happens on only one side of the body. Sometimes it affects both sides, but this is rare. A ureterocele can block urine flow or cause urine to flow backward (backflow), which can result in:

• Frequent urinary tract infections (UTIs).
• Kidney damage.

What are the causes?

The cause of this condition is not known.

What increases the risk?

This condition is more likely to develop in children who are:

• Girls.
• White (Caucasian).
• Born with an extra ureter.

What are the symptoms?

A ureterocele may not cause any symptoms. If your child does have symptoms, they may include:

• Back or side pain.
• Frequent UTIs. Symptoms of a UTI may include:
  • Fever.
  • Frequent urination or passing small amounts of urine frequently.
  • Needing to urinate right away (urgently).
  • Pain or a burning sensation with urination.
  • Urine that smells bad or unusual.
  • Cloudy urine.
  • Pain in the lower abdomen or back.
  • Bed-wetting.
  • Trouble urinating.
  • Blood in the urine.
  • Irritability.
  • Vomiting or refusal to eat.
  • Loose stools.
  • Sleeping more often than usual.
  • Being less active than usual.
  • Vaginal discharge for girls.
• Abdominal swelling.

How is this diagnosed?

This condition is often diagnosed before birth, during a routine prenatal ultrasound. After birth, your child’s health care provider may suspect this condition if your child has frequent UTIs. Your child’s health care provider will also do a physical exam. This may include collecting a urine sample to check for infection. Your child may have tests, such as:

• Ultrasound of the kidneys, ureters, and bladder.
• Voiding cystourethrogram. In this test, dye is put into your child’s bladder, and X-rays are taken while your child urinates. X-rays are taken of the kidneys, ureters, and bladder.
• MRI.
• CT scan.

How is this treated?

A small ureterocele that does not cause backflow, urine blockage, or frequent infections may not need treatment. In some cases, your child may need:

• Antibiotic medicine to help treat or prevent infection.
• Surgery to:
  • Remove the swelling.
  • Repair the ureter.
  • Remove the ureter or the kidney.

Follow these instructions at home:

• Give your child over-the-counter and prescription medicines only as told by your child’s health care provider.
  • If your child was prescribed an antibiotic medicine, give it as told by your child’s health care provider. Do not stop giving the antibiotic even if your child starts to feel better.
• Have your child drink enough fluid to keep his or her urine pale yellow.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if your child has:

• Chills or a fever.
• Symptoms of a UTI.
• Belly pain or swelling.

Get help right away if your child:

• Is younger than 3 months and has a temperature of 100.4°F (38°C) or higher.
• Has severe pain or pain that gets worse.
• Is not passing urine.

Summary

• A ureterocele is an abnormal swelling at the end of a ureter, near the bladder.
• A ureterocele can block urine flow or cause urine to flow backward (backflow), which can result in frequent urinary tract infections (UTIs) or kidney damage.
• Treatments may include antibiotic medicine or surgery.