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Ureterocele

By Philip E. Gleason, MD

We have discussed ectopic kidneys and renal agenesis from the standpoint of the kidney in the ectopic kidneys and renal agenesis topic section. This topic section will now discuss ectopic ureters and ureteroceles more from the ureter and bladder perspective. Of note is that there is a lot of variation in ectopic ureters and ureteroceles. We will discuss summary information regarding their diagnosis and evaluation, their management and treatment, and their follow-up.

Ectopic ureters and ureteroceles result from an abnormal ureteral bud arising from the bladder. This results in an abnormal, or ectopic, insertion of the ureter into the bladder, or perhaps even outside or away from the bladder. This can also result in an abnormal outpouching of the ureter into the bladder, known as a ureterocele. Often with ectopic ureters and ureteroceles, the ureteral bud has split into two ureters and one of these is ectopic or forms a ureterocele, while the other may be more normal in the bladder. Thus, these can vary form very mild abnormalities which can be normal anatomic variants and can be more normal than abnormal, to more serious abnormalities.

Ectopic ureters and ureteroceles can come to attention at any age and with a variety of symptoms and findings. They may be demonstrated on in-utero ultrasounds with hydronephrosis. They may present as an enlarged kidney or abdominal mass on newborn physical exam. They may be associated with either vesicoureteral reflux or obstruction and produce urinary tract infections. They may also insert down below the bladder, and as mentioned in females, produce urinary incontinence. Often their diagnosis requires a high index of suspicion and thorough x-ray evaluation such as a VCUG and kidney x-rays including a renal ultrasound or renal scan or IVP or CT or MRI, etc.

The treatment of ectopic ureters and ureteroceles depends on several factors. A thorough evaluation will be necessary to precisely determine the exact anatomy and function of the kidney and ureter or ureters. If there is good kidney tissue and function, attempts to puncture the ureterocele or re-implant and re-route the ureter into the bladder may be warranted. If there is absent or scarred and abnormal dysplastic kidney tissue, it may be wisest to consider removing that portion of the kidney to protect against infections and to protect the more normal kidney tissue. However, each patient is a very unique and individualized situation. As such, specific details will vary accordingly and will need to be individualized in discussion with your physician and Pediatric Urologist.