In a normal urinary tract, each kidney is connected to a ureter. The ureter is the tube that drains urine into the bladder.
A ureterocele is a balloon at the end of the ureter inside the bladder. It appears as a thin-walled balloon inside the bladder.
Characteristics of the ureteroceles
Ureteroceles vary in size, some barely visible, while others can occupy most of the bladder.
Ureteroceles can be within the bladder (intravesical) or extend outside the bladder, through the bladder neck and urethra (ectopic or extravesical).
The opening of the ureterocele into the bladder may be narrow (causing some degree of obstruction), regular in size, or more significant.
Ureteroceles can be associated with a single system (a kidney and a ureter) or a duplex kidney (a kidney with two separate ureters).
Ureteroceles can be associated with vesicoureteral reflux. Vesicoureteral reflux occurs when urine in the bladder flows back to one or both ureters and often the kidneys.
The causes of ureterocele are still unknown. However, some cases have been reported in siblings, suggesting that its cause may be genetic.
Symptoms of ureterocele
The typical symptom of this condition is recurrent urinary tract infections.
Due to the increase in the use of prenatal ultrasounds, many babies have hydronephrosis even before they are born.
An ultrasound of the kidneys and bladder is done within the first few days after birth as part of the postnatal treatment of babies with hydronephrosis.
It is during an ultrasound to diagnose hydronephrosis that a ureterocele is identified. In some babies, the ureterocele can be seen in prenatal pictures.
Because reflux and vesicoureteral obstruction can be associated with a ureterocele, it can predispose children to a urinary tract infection.
Once the urinary tract infection is diagnosed, an additional radiology study can identify the ureterocele.
Your doctor may prescribe a low dose of antibiotics to inhibit the growth of bacteria and prevent other urinary infections. This is called antibiotic prophylaxis.
The child may undergo a variety of tests to help us confirm the diagnosis and better understand the extent of the disease, such as:
Renal bladder ultrasound
This procedure uses sound waves to outline the kidneys and bladder. If there is a ureterocele, it can be identified during bladder views.
A catheter is placed through your child’s urethra into the bladder. The tube will be used to fill your bladder with a solution slowly.
While the bladder is filling, a particular machine (fluoroscopy) is used to take pictures. As the bladder fills, the ureterocele can be identified.
In addition, the radiologist watches to see if any of the solutions return to the kidneys, confirming the diagnosis.
MAG III kidney scan
This study will determine how each kidney works and assess the degree of blockage, if any.
DURING THIS TEST, an IV line is used to inject a unique solution called an isotope into your veins.
The isotope allows the kidneys to be seen clearly. Pictures of the kidneys will be taken with a large x-ray machine that rotates around the patient.
Magnetic resonance imaging and magnetic resonance urography
MRI is a radiation-free diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of the body.
Magnetic resonance urography creates detailed images of the kidneys, ureters, and bladder.
Treatment of ureterocele
Not all ureteroceles are the same; many can be managed, but others may require more extensive surgery.
Doctors will consider the treatment options that are most appropriate for the child.
Treatment of a ureterocele depends on many factors:
- The size of the ureterocele.
- The degree of obstruction.
- Kidney function.
- If the bladder has been affected.
Fluids and antibiotics should be given intravenously when the patient has a urinary tract infection.
Once the urinary tract infection is combated, the ureterocele will be addressed.
This is usually an outpatient procedure under general anesthesia.
During surgery, a lighted tube, called a cystoscope, is inserted into the opening of the urethra to view the inside of the bladder without incisions.
When the ureterocele is identified, a small incision is made to pierce it.
This procedure is performed under general anesthesia and through a lower abdominal incision, the ureterocele is removed, and the ureter is reimplanted where it joins the bladder.
The bladder floor and neck may need to be rebuilt to improve urinary continence.
This procedure can be performed through minimally invasive surgery, using a laparoscopic or robotic method.
Focusing is achieved through three small incisions, the size of a grain of rice.
The benefits are more minor, less visible incisions, and a faster recovery period. The minimally invasive technique is not appropriate for all children.
Upper pole nephrectomy
If the ureterocele is associated with a duplex kidney and the upper pole of the kidney is found to have no function, and upper pole nephrectomy may be recommended.
This procedure can be done through minimally invasive surgery.