What Is Ureterocele

• The congenital abnormality known as ureterocele is a bulging or balloon-like expansion at the lower end of one or both ureters, which are the tubes that deliver urine from the kidneys to the bladder. This condition occurs when the ureter's opening into the bladder becomes obstructed or forms a pouch-like structure. Ureterocele can cause various urinary symptoms and requires medical intervention to manage effectively.
• Read on to explore a comprehensive overview of ureterocele, including its causes, symptoms, management, and treatment options. By understanding this condition better, you'll be equipped with the knowledge to navigate potential challenges and make informed decisions regarding your health or the health of a loved one.

Overview

Ureterocele is a relatively rare congenital condition that affects the urinary system. It occurs when the ureter's opening into the bladder, known as the ureteral orifice, becomes obstructed or forms a pouch-like structure. This bulging or balloon-like enlargement typically affects only one ureter, but in some cases, both ureters can be involved.

In individuals with ureterocele, there is an abnormality in the ureteral orifice, which is the opening of the ureter into the bladder. This anomaly can take two main forms:

• Obstruction: The ureteral orifice becomes partially or completely obstructed, impeding the flow of urine from the ureter into the bladder. This obstruction can be caused by a narrowing or blockage of the opening, leading to urine accumulation in the affected ureter.
• Pouch Formation: Instead of a smooth, narrow opening, a pouch-like structure develops at the ureteral orifice. This structure is called the ureterocele and can vary in size and shape. It can resemble a bulge or a balloon-like enlargement protruding into the bladder.

Ureterocele can occur in one or both ureters, although it is more commonly unilateral. When ureterocele affects both ureters, it is known as bilateral ureterocele. The severity of the anatomical anomaly can also vary, with some ureteroceles causing mild obstructions or pouch formations, while others may result in significant blockages.¹

Causes of ureterocele

The exact cause of ureterocele is not fully understood. However, it is believed to be a result of a developmental abnormality during fetal development. The condition is often associated with other congenital urinary tract abnormalities, such as vesicoureteral reflux (VUR) or duplex collecting systems. In rare cases, ureterocele may also develop later in life due to scarring or trauma to the ureter.²

Signs and symptoms of ureterocele

The signs and symptoms of ureterocele can vary depending on the severity and location of the ureterocele. In some cases, ureterocele may not cause any noticeable symptoms and is incidentally discovered during imaging tests for other reasons. Symptoms may include:

• Urinary tract infections (UTIs)
• Fever
• Frequent urinary tract infections
• Hematuria (blood in the urine)
• Urinary incontinence or leakage
• Unpleasant urine odour 
• Pain or discomfort in the lower abdomen
• Difficulty emptying the bladder completely
• Pain or burning while urinating 
• Bedwetting 
• Urinary retention^2,4

Management and treatment for ureterocele

The management and treatment of ureterocele depend on several factors, including the severity of symptoms, the size of the ureterocele, and the presence of associated complications. In mild cases where the ureterocele does not cause significant symptoms or complications, a watchful waiting approach may be adopted, with regular monitoring and conservative measures to prevent urinary tract infections.

However, if the ureterocele is causing persistent symptoms or complications such as recurrent UTIs, vesicoureteral reflux, or kidney damage, intervention may be necessary. Treatment options for ureterocele may include:

• Endoscopic incision: This minimally invasive procedure involves making a small incision in the ureterocele using a cystoscope, a thin tube with a camera. It aims to create a wider opening for urine to flow freely from the affected ureter into the bladder.
• Surgical reconstruction: In more complex cases, surgical reconstruction may be required to correct the abnormality. This procedure involves removing the ureterocele and reconstructing the affected portion of the urinary tract to restore proper urine flow.³

Diagnosis of ureterocele

The diagnosis of ureterocele typically involves a combination of medical history evaluation, physical examination, and diagnostic tests. The following methods may be utilized to diagnose ureterocele:

• Imaging tests: Ultrasound, intravenous pyelogram (IVP), or voiding cystourethrogram (VCUG) may be used to visualize the urinary tract and identify the presence of a ureterocele.
• Cystoscopy: A cystoscope is a thin tube with a camera that can be inserted through the urethra and into the bladder to directly visualize the ureterocele and assess its characteristics.⁴

Risk factors

While the exact cause of ureterocele remains unclear, several factors may increase the risk of developing this condition:

• Gender: Ureterocele is more commonly found in females than in males.
• Family history: Having a family history of ureterocele or other urinary tract abnormalities may increase the risk.
• Other congenital abnormalities: Ureterocele is often associated with other congenital urinary tract abnormalities, such as vesicoureteral reflux or duplex collecting system.

Complications

If left untreated or unmanaged, ureterocele can lead to various complications, including:

• Recurrent urinary tract infections: The presence of a ureterocele can increase the risk of frequent urinary tract infections, which, if left untreated, can lead to kidney infections or damage.
• Vesicoureteral reflux: Ureterocele is often associated with vesicoureteral reflux, a condition where urine flows backwards from the bladder to the ureters and potentially to the kidneys. This reflux increases the risk of urinary tract infections and kidney damage.
• Kidney damage: In severe cases or when ureterocele is associated with vesicoureteral reflux, the kidneys may be at risk of damage or impairment due to recurrent infections or obstruction of urine flow.⁴

FAQs

How can I prevent ureterocele?

As ureterocele is a congenital condition, it is not possible to prevent it. However, proper prenatal care and early detection through prenatal ultrasounds can help identify ureterocele early on, allowing for timely management and treatment.

How common is ureterocele?

Ureteroceles are more frequent in duplex kidneys, which are kidneys with two ureters that empty into the bladder and occur in roughly one out of every 1,000 births.⁵

When should I see a doctor?

If you or your child experience persistent urinary symptoms, recurrent urinary tract infections, or blood in the urine, it is advisable to seek medical attention. A healthcare professional can evaluate your symptoms, perform the necessary tests, and provide appropriate guidance and treatment options.

Summary

Ureterocele is a congenital abnormality that affects the urinary system, specifically the ureters and their opening into the bladder. It involves an anatomical anomaly at the ureteral orifice, resulting in an obstruction or the formation of a pouch-like structure known as the ureterocele. This condition can affect one or both ureters and is believed to be a result of developmental abnormalities during fetal development, potentially influenced by genetic factors or other congenital urinary tract abnormalities.

Ureterocele can cause various urinary symptoms and complications, such as urinary tract infections, vesicoureteral reflux, and potential kidney damage. Diagnosis typically involves a combination of medical history evaluation, physical examination, and imaging tests, such as ultrasound, intravenous pyelogram (IVP), or cystoscopy.

The management and treatment of ureterocele depend on the severity of symptoms, the size of the ureterocele, and the presence of associated complications. However, persistent symptoms or complications may require intervention, which can include endoscopic incision or surgical reconstruction to alleviate the obstruction and restore proper urine flow.

Ureterocele is considered a relatively rare condition, and individuals experiencing persistent urinary symptoms, recurrent urinary tract infections, or blood in the urine should seek medical attention for evaluation and guidance.