ureterocele

A ureterocele occurs in the lower part of the ureter, where the tube enters the bladder. The swelling prevents urine from moving freely into the bladder. The urine collects in the ureter and stretches its walls, blowing it up like a water balloon.

Ureteroceles occur in about 1 in 500 to 1 in 4,000 people. Caucasians are most likely to be affected. Ureteroceles are equally common in both left- and right-side ureters.

Large ureteroceles are usually diagnosed earlier than smaller ones. A ureterocele may be discovered before the baby is born (during a pregnancy ultrasound).

Children with this condition often have severe urinary tract infections. Some persons with ureteroceles do not know they have the condition. Often, the diagnosis is made later in life due to kidney stones.

• Flank pain
  • Severe
  • May travel or radiate to the groin, genitals, thigh
  • Spasms
  • On one side
• Back pain, possibly only on one side
• Urinary tract infection
• Fever
• Burning pain while urinating (dysuria)
• Foul-smelling urine
• Abdominal pain
• Blood in the urine
• Increased urinary frequency and urgency
• Palpable abdominal mass
• Urinary incontinence
• Ureterocele prolapse (can be sent through the female urethra and vagina)

A urinalysis may reveal blood in the urine or signs of urinary tract infection.

The following tests may be performed:

• Pyelogram
• Abdominal ultrasound  
• CT scan of the abdomen
• VCUG (voiding cysto-urethrogram)
• Radionuclide renal scan
• Cystoscopy

Blood pressure may be high if there is kidney damage.

Antibiotics are usually given to prevent further infections until surgery can be done. Ampicillin or Bactrim are commonly used.

The goal of treatment is to get rid of the blockage.  Stents (drains placed in the ureter or in the renal area) may provide short-term relief of symptoms.

Surgical repair of the ureterocele usually cures the condition. Surgery involves making a cut into the ureterocele ("popping the water balloon") or removing the ureterocele and reattaching the ureter to the bladder. Which surgery is performed depends on the severity of the obstruction.

The outcome varies. If the obstruction can be cured, the damage may be temporary. However, damage to the kidney may be permanent, especially if the condition persists. Kidney failure is uncommon because the other kidney usually continues to work as normal.

• Permanent kidney damage, with a decrease or loss of function (one kidney)
• Chronic or recurrent urinary tract infection
• Permanent bladder damage (incontinence/urinary retention)

Call your health care provider if symptoms indicate ureterocele may be present.

Walsh PC. Campbell's Urology. 8th ed. St. Louis, Mo: WB Saunders; 2002:2022-2034. 

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:774.