Ureteroceles

Abstract

Ureteral duplication occurs in nearly 1 % of the general population. Congenital anomalies associated with duplicated collecting systems include vesicoureteral reflux, ureterocele, and ectopic ureter. Eighty percent of ureteroceles in children occur in duplex systems and involve the upper pole ureter. With the advent of prenatal ultrasound and its increased use, most ureteroceles are detected prenatally, allowing for early institution of prophylactic antibiotics and thus decreasing postnatal morbidity. Clinical presentations of ureteroceles are typically related to urinary tract infections or urosepsis. Renal and bladder ultrasonography and voiding cystourethrography identify the ureterocele and associated anomalies. Dimercaptosuccinic acid renal scan and diuretic renography assess renal function and drainage, respectively. The management of ureteroceles is typically surgical but varies depending on a variety of factors including: presentation, degree of upper pole renal function, presence/absence of vesicoureteral reflux, and the type of ureterocele, intravesical versus ectopic. Surgical options include transurethral incision of the ureterocele, upper pole nephroureterectomy, ureteroureterostomy or ureteropyelostomy, or excision of the ureterocele and common sheath ureteral reimplantation. Often, depending on the complexity of the anatomy and renal function, more than one surgical procedure is required. Rarely, in the setting of good upper pole renal function and drainage or a nonfunctioning upper pole associated with no other significant anomalies, a nonoperative approach is used. The management of ureteroceles remains individualized.