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Ureterocele is a cystic dilatation of the distal ureter and is a rare cause of urinary tract obstruction. It is commonly found in infants and young children and is more prevalent in females than in males. This report presents the case of a 59-year-old woman who suffered right flank pain and was diagnosed with ureterocele. The patient was treated with endoscopic surgery and unroofing of the ureterocele.

The present study aimed to assess the diagnostic efficacy of contrast-enhanced voiding urosonography (ceVUS) using SonoVue for evaluating duplex kidneys, and to compare it with fluoroscopic voiding cystourethrography (VCUG).

Ectopic ureterocele is a rare anomaly of the upper urinary tract, often accompanied by the growth of secondary stones caused by impaired urinary outflow. The article presents a clinical case, which shows the peculiarities of diagnosis and possibilities of surgery of this condition, including minimally invasive endoscopic interventions. Emphasis is placed on the consideration of different surgical approaches and their effectiveness in improving the quality of life of patients. Comparative analysis of different techniques shows that endoscopic correction, despite some limitations, remains the preferred option due to the low incidence of complications and rapid rehabilitation.

Ureterocele is a rare congenital anomaly characterized by the dilation of the distal ureter and its protrusion into the bladder, often related with duplex collecting renal system, leading to urinary obstruction.While it commonly occurs in females, this case report presents the rare presentation of a massive ureterocele in a 2-day-old male neonate, causing urinary retention. A diagnostic workup revealed bilateral hydronephrosis and a massive ureterocele. Surgical intervention with endoscopic decompression of the ureterocele successfully alleviated the obstruction.At one year follow-up, patient was completely asymptomatic and serial follow-up ultrasonography demonstrated resolution of hydronephrosis, highlighting the successful management.

Ureteroceles are the most prevalent urinary tract malformations in humans. Only 5% of ureteroceles are predicted to prolapse and it usually occurs in childhood. We outline the clinical history, radiological results, and a potential course of treatment for this challenging condition. A 32-year-old female checked herself into our institution with complaints of burning urination and 20 years of complaints of urethral ballooning when urinating. Initial sonographic evaluation revealed that at the left vesicoureteric junction, a cystic lesion extends into the bladder, with a hyperechoic focus causing posterior acoustic shadowing. CT scan confirmed the diagnosis of an ureterocele with calculus. A voiding cystourethrogram revealed a left-sided ureterocele that descends down the urethra and into the interlabial region. CT cystogram verified the presence of a left-sided cecoureterocele with calculus. Cecoureterocele is a rare variant of ectopic ureteroceles. Girls experience this condition more frequently than boys, and they are predisposed to vesicoureteric reflux and recurrent infections. To prevent problems like renal function loss, recurrent urinary tract infections, and urinary incontinence, it is important to gain diagnostic confirmation of these circumstances. Less invasive surgical techniques like endoscopic ureterocele puncture or even nonoperative treatment appear to produce comparable functional outcomes. When a patient arrives with a urethral protrusion, one should be extra cautious. In this case report, a cecoureterocele that has prolapsed is presented in a rare way. It presents an important chance to evaluate the clinical and diagnostic characteristics of this urinary tract abnormality.

Background: Duplex kidneys may be associated with additional pathologies with an indication for surgery. Various surgical approaches have been described. However, little is known about long-term outcomes and quality of life (QoL) for these patients. Objective: To present long-term outcomes and QoL data up to 30 yr after surgical treatment of duplex kidneys and associated pathologies. Design, setting, and participants: We collected clinical and operative data for all patients who underwent surgery for complicated duplex kidney at our institution from 1990 to 2018. All patients were invited for a follow-up examination or telephone interview. Outcome measurements and statistical analysis: We evaluated renal function, clinical outcomes, residual dilation of the upper urinary tract, and health-related QoL. Results and limitations: Of the 176 patients included, 173 were available for follow-up (mean 140.5 mo). Surgical treatment involved an upper-tract, lower-tract, or combined approach in 11%, 56%, and 33% of cases, respectively. Rates of perioperative complications (8%) and secondary surgery (10%) were low. Overall, 95% of our patients achieved full restitution. Renal function was preserved in all cases, with recurrent urinary tract infections reported by just 2% and urinary incontinence by 1%. Good health-related QoL was reported by 98% of patients. Those without full restitution included six patients who underwent total nephrectomy and two boys who underwent multiple surgeries and urinary diversion. Our results are limited by their retrospective nature, including partly incomplete data sets. Conclusions: Management of duplex kidneys and associated pathologies is complex and highly individual. By planning a personal approach for each patient it is possible to achieve full bodily integrity and good QoL for most of these patients. Patient summary: Almost all patients undergoing surgery for duplex kidneys and associated pathologies will lead a life without body impairment and good quality of life.This trial is registered in the German Clinical Trials Register as DRKS00022542.

Introduction: Ureterocele is a congenital malformation of the urinary tract, characterized by the cystic dilation of the terminal ureter. Its treatment is indicated in symptomatic patients. Over the years, surgical treatment has evolved from open surgeries to minimally invasive procedures. The aim of this study was to assess the long-term outcomes of a case series involving pediatric patients with ureterocele, who were treated using an endoscopic puncture. Material and methods: A retrospective review was performed of ureterocele patients treated by endoscopic puncture from 2002 to 2021. The primary outcome of the study was relief of the obstruction with a single endoscopic puncture. Results: From 2002 to 2021, a total of 34 patients with 39 ureteroceles underwent treatment using this technique. The mean age at diagnosis was 16 months. Diagnoses was made prenatally through an ultrasound revealing a dilated urinary tract in 17/34 (50 %) of patients and during the assessment of a urinary tract infection in 15/34 (44 %) of patients. A duplex collecting system was observed in 28/34 (82 %) of patients, while bilateral ureteroceles were found in 5/34 (15 %) of patients. A single endoscopic puncture of the ureterocele proved to be successful in 27/34 (79 %) of patients. A second endoscopic puncture was needed in 4/34 (12 %). Only 3/34 (9 %) patients required a surgical intervention. The mean follow-up period was 4 years. Conclusion: The results of our study show that endoscopic puncture of obstructive ureterocele is a procedure with excellent long-term results.

Background. Ureterocele is a cystic dilatation of the distal ureter. Orthotopic ureterocele is relatively rare form of this disease, and it is commonly diagnosed in female children. The clinical picture of orthotopic ureterocele is usually not significant, and the management variants are unclear. Clinical case description. Ultrasound has revealed dilatation in the distal part of the left ureter (up to 6.5 mm) and cyst formation (diameter of 8 mm, thick walls) in the bladder in 8-months-old boy. The retrograde voiding cystourethrogram has shown no signs of vesicoureteral reflux. The evaluation of the voiding rhythm was performed: the volume of residual urine was > 30%, it indicates the infravesical obstruction. The child underwent diagnostic cystourethroscopy, transurethral resection of the ureterocele, intubation ureteral catheter in the left ureter (all procedures was performed under general anesthesia). There were no enlargements of calices-pelvis system and ureters 12 months after surgery according to urinary system ultrasound. Clinical urine test with no inflammatory changes. Voiding rhythm was without pathology.Conclusion. The widespread implementation of high-tech and minimally invasive methods of diagnosis and management allow us to achieve timely detection and provide effective treatment for children with ureterocele.

Abstract Background Duplex kidney is a relatively common renal anomaly with a wide array of associations. With routine antenatal screening it is increasingly diagnosed these days. With this study, we aim to assess the clinical profile, prevalence of vesicoureteric reflux and highlighting the need for aggressive workup and management in selected cases to prevent further renal damage. Results Fifty-three children with duplex kidneys who attended the department of pediatric surgery at our institution from December 2016 to December 2021 were included in the study. The most common mode of presentation was urinary tract infection (58%). Fifty-three percent had an antenatally detected renal anomaly (out of these 46% were asymptomatic, 33% had UTI and 11% had other symptoms like straining, incontinence and abdominal mass). Sixty-one percent of patients were conservatively managed and 19 patients needed surgical intervention. Ureterocele was the most common condition necessitating surgery. Prevalence of vesicoureteric reflux was 60% and was comparable with other studies. Thirty-six percent of patients had renal scarring. Among the patients with scarring, 84% had VUR and 63% had febrile UTI. Conclusion Duplex kidney though a common congenital anomaly, requires a systematic evaluation to detect its various associations and a structured management protocol according to the associations. It has a high incidence of VUR which is a potentially hazardous condition which can affect the renal function if not evaluated and managed appropriately. Duplex can also be associated with obstructive conditions like PUJO, ureterocele, and ectopic megaureter which can cause rapid deterioration of renal function if not managed early enough. Though majority of the patients need only follow-up and antibiotic prophylaxis, there may be a certain sub group of patients who develop early scarring and need aggressive management. Our study aims to highlight the need to detect such patients early enough to reduce the morbidity.

Aim: The presence and clinical importance of vesicoureteric reflux in patients with a double collecting system are being questioned. Therefore, the role of voiding cystourethrography in the management of patients with ureterocele is unclear. This study aimed to evaluate patients with a ureterocele in terms of urinary tract infection (UTI) and vesicoureteral reflux (VUR). Material Methods: The cases who were admitted to the Pediatric Nephrology Clinic of Health Sciences University Tepecik Training and Research Hospital between 2012 and 2022 and were diagnosed with ureterocele were evaluated retrospectively. Demographic, clinical, and laboratory data were obtained from file records. Results: All patients diagnosed with ureterocele and voiding cystourethrography (VCUG) were evaluated. A total of 24 (female 13 (54.2%)) children were included. The reasons for admission were antenatal hydronephrosis in 13 (54.2%) patients, UTI in 9 (37.5%) patients, and incidentally diagnosed ureterocele in 2 (8.3%) patients. Urinary tract infection was observed in 20 patients at admission, recurrent UTI in 21 patients at follow-up, preoperative pyelonephritis in 12 patients. VUR was found in 11 patients, and severe VUR (≥stage 3) was found in 9 patients. Ten patients had ipsilateral hydronephrosis, and 14 patients had a double collecting system. The presence of VUR was found to be associated with female gender, UTI at admission, and recurrent UTI at follow-up (p < 0.05). However, there was no difference between groups with or without VUR in terms of ipsilateral hydronephrosis, scar formation, and the need for surgery (p > 0.05). Conclusions: We could not demonstrate any criteria to select patients to receive VCUG; on the other hand, VUR did not cause more kidney damage. Our study supports the need for more scientific data to determine management in patients with ureterocele.

Congenital renal anomalies are among the most common birth defects. They are often detected antenatally. If not, they can manifest in adulthood with variable clinical presentations. Herein, we present a case of a 72-year-old male patient who was incidentally found to have an extremely rare combination of urinary tract defects comprising: right-sided unilateral renal agenesis, blind ureter, and ectopic ureterocele.

Ureterocele is rare urinary malformation. We reported a 12-month-old girl case with a prolapsed ectopic ureterocele in the vulva. Urinary catheterization was used as an emergency treatment to minimize the ureterocele. The patient later benefited from an upper polar hemi-nephrectomy, which helped to resolve the issue partially. She sought treatment for the prolapse again a Three month later, this time ureterecelectomy with ureteral reimplantation was employed. The non-consensual management of this malformation must be initiated as soon as possible to prevent complications. The first treatment goal was to decompress the prolapsed ureterocele and remove it endoscopically.

Introduction Incomplete sagittal septum of the urinary bladder is an extremely rare congenital anomaly and one of the variations in bladder duplication. Herein, we report a case of incomplete sagittal septum of the bladder with cystolithiasis. Case presentation A 20‐year‐old man was referred to our department for examination and treatment of symptomatic cystolithiasis and a suspected giant ureterocele on the left side. Cystoscopy and urography performed under general anesthesia revealed anatomical structures suggestive of the sagittal septum of the bladder. Subsequently, transurethral septostomy and cystolithotripsy were performed. The detrusor muscle was microscopically identified, leading to the diagnosis of an incomplete sagittal septum of the bladder. Conclusion Although extremely rare, an incomplete sagittal septum of the bladder may be difficult to differentiate from a ureterocele, and should be considered when a large cystic lesion is found in the bladder.

Purpose To present the outcomes of revascularized pyeloureterocystoplasty with ureterocele unroofing in end stage bladder patients with duplex system and ureterocele. Methods Thirteen patients with obstruction of intrauterine outlet from an ectopic obstructive ureterocele were included. Fourteen units of duplex systems underwent upper pole partial nephrectomy in conjunction with augmentation revascularized pyeloureterocystoplaty and ureterocele unroofing. The anterior and lateral walls of the ureterocele were excised before cystoplasty, and the resultant edges of the posterior wall were sutured to the bladder epithelium. Anastomosis of the upper pole vein and artery to the inferior iliac artery and the common iliac vein was performed. Detubularization of the whole ureter was performed with exception of the intramural ureteric part that kept tubularized for ‘jet/turbulent’ occurrence. Five patients (control group) underwent pyeloureterocystoplasty without revascularization. Patients underwent several evaluations in long-term follow-up. Results Patients were all dry by day and night in our long-term follow-up. Urinary incontinence improved in patients with no need for re-augmentation technique. Vesicoureteral reflux subsided in all patients postoperatively except one, who was asymptomatic. After five years, median bladder capacity rose from 128.5 ml to 395 ml and bladder compliance showed significant improvement from 15 ml/cm H2O to 29 ml/cm H2O, in experimental group and remained stable for 24–36 months. Median bladder capacity did not rise significantly in control group. Conclusion Pyeloureterocystoplasty is an efficient choice in this type of patients, which may prevent the recurrence of hypocompliant bladders and prevent ischemia and subsequent fibrosis.

Ureterocele, a type of ectopic ureter characterized by cystic dilation of the distal ureter, can sometimes contain stones. Here, we present the case of a 67-year-old woman who was under observation for ureteral stone and experienced spontaneous ureterocele wall ruptured due to the stone. As illustrated in the present case, conservative observation, which is recommended as initial management of stones in ureterocele to reduce the risk of vesicoureteral reflux following transurethral ureterocele incision, may be associated with increased risk of ureterocele wall rupture and subsequent vesicoureteral reflux.

None.

Background: The ectopic ureter is any single or duplex ureter that enters beyond the anatomical area of the triangle of the urinary bladder. Abnormal ureter opening is one of the rare defects resulting from abnormalities in fetal development. The present study focuses on an up-to-date narrative review of the clinical and anatomical aspects of the ectopic ureter and coexisting urinary tract abnormalities. Materials and methods: This review includes an analysis of the literature on the ectopic ureter and coexisting urinary tract anomalies. A query was conducted in electronic databases (PubMed, Web of Science, and ScienceDirect) to investigate the abovementioned topic. The literature search was based on the following criteria and keywords: ectopic ureter, duplication of the ureter, and ureterocele. The date and language of publication were not the exclusion criteria. Conclusion and outcome of the review: The ectopic ureter is one of the anomalies among congenital abnormalities of the kidney and urinary tract. In about four out of five cases, it coexists with other defects of the upper urinary tract, such as ureter duplication and ureterocele. Urinary incontinence is the main symptom of ectopic ureter among women due to the most common location of the ureter orifice below the bladder sphincter. It may be asymptomatic or mildly symptomatic in men and cause recurrent epididymitis or urinary tract infections. Treatment of this disease consists of constant observation by regular control visits, and when the abnormality becomes symptomatic, a surgical procedure should be performed. It should be underlined that after finding an anatomical defect of the urinary system, clinicians should consider whether it causes disturbing symptoms and whether its corrective maintenance operation will be beneficial to the patient.

Ureterocele is a distal ureteral segment cystic dilatation. Its prevalence in women ranges from 1/5000 to 1/12000.A 22-year-old adult female presented with a vulvar tumor with left-side pain. She was a candidate for an interlabial lump biopsy. A vulvar growth mimicking a uterine polyp was identified during her further evaluation. On ultrasonography of the abdomen and pelvis, a left-sided hydronephrisis (grade 1), proximal ureteral dilatation, and a ureterocele related to the distal portion of the left ureter that protruded into the urethra were detected. Under anesthesia examination, the ureterocele was removed.

Abstract Background Association of the ureterocele and proximal ureteral valve is a rare congenital anomaly which can lead to quick detoriation of renal function due to double obstruction. Though ureteral valves have been associated with other ureteral anomalies, this specific association is extremely rare. Case presentation A 7-month-old boy was referred to us for antenatally detected hydronephrosis. Provisional diagnosis of orthotopic ureterocele with pelviureteric junction (PUJ) obstruction was made based on preoperative imaging. Endoscopic incision of ureterocele was done and retrograde pyelography showed tight obstruction at PUJ which necessitated a pyeloplasty. Examination of resected specimen confirmed a ureteral valve. Postoperatively, the patient had good improvement in kidney function. Conclusion To conclude, congenital ureteral valves are a rare cause of ureteric obstruction and its association with ureterocele is rarer still. Identification of an ureterocele should not deter us from searching for an associated pathology like a ureteric valve when imaging shows more severe hydronephrosis suggestive of more proximal obstruction.

A 2-year-old Yorkshire Terrier was presented with haematuria and dysuria. On the ultrasonography, an irregularly shaped, cystic, intraluminal urinary bladder mass was identified at the left ureterovesical junction. The computed tomographic excretory urography and magnetic resonance imaging revealed a pouch-like cystic mass arising from the distal ureter embedded at the ureterovesical junction. The distal portion of the mass prolapsed into the proximal urethra and obstructed the urethral lumen. The multimodal imaging findings were consistent with a prolapsed ureterocele and were further confirmed with surgery and histopathology. After surgical removal of the mass, the clinical signs clearly improved. To the best of our knowledge, this is the first report of multimodal imaging characteristics and the outcome of a prolapsed ureterocele in a dog.

Abstract Background Kidney triplication is a rare urological abnormality. Association of triplex kidney and ureterocele is out of ordinary. Treatment of such patients usually implies heminephrureterectomy of the upper moiety. We report a case of a saved function of the upper moiety after minimal invasive surgical procedure. Case presentations 5-year old girl complained for continuous wetting. Examination revealed 3 - segmented left kidney with pelvi-ureteric dilation of the upper moiety, IV grade vesicoureteral reflux in the upper moiety, cervical ectopic ureteral orifice of the upper moiety and a commune ureteral orifice of the lower segments. An endoscopic laser dissection of ureterocele was performed. Drainage of the upper moiety of triplex kidney was restored. Examination 18 months later showed no wetting and infection symptoms. Pelvi-ureteric dilation of the upper moiety and cavity of ureterocele decreased to minimal. Grade of vesicoureteral reflux decreased to I. Conclusion Minimal invasive elimination of obstruction of the upper moiety of triplex kidney was successful and led to regress of vesicoureteral reflux, urinary incontinence and let to avoid heminephrectomy.

Abstract Background Duplex kidneys are one of the most common renal congenital abnormalities, mostly asymptomatic and of no clinical significance. There are little reports about the left ureterocele and stone of calyceal diverticulum in patients with bilateral incomplete duplex kidneys managed by flexible ureteroscopy. Case presentation A 69-year-old Chinese woman was presented with left waist pain for 1 month. A preoperative computed tomography (CT) scan and intravenous pyelogram revealed the left ureterocele which located in the left ureterovesical junction, and stone of calyceal diverticulum which located in the upper kidney of left incomplete duplex kidneys. The ureterocele was confirmed in view of ureteroscopy and the holmium laser was used for the resection of ureterocele. It took us a lot of efforts to find out the stone because of diverticular neck stenosis. Fortunately, when diverticular neck stenosis was incised internally by holmium laser, the stone was discovered clearly and removed using the holmium laser and nitinol stone basket through flexible ureteroscopy. A double-J ureteral stent was inserted and remained in place for 1 month. The symptom disappeared postoperatively and no complications were developed during the placement of the stent. There were no stone residents observed on CT scan before removing the ureteral stent 1 month later. Conclusions Flexible ureteroscopy with holmium laser is feasible to manage the ureterocele and calyceal diverticulum stones in patients with bilateral incomplete duplex kidneys in one operation.

Introduction There are no established treatments for asymptomatic ectopic ureteroceles, with completely duplicated ureters, during the neonatal period and infancy. However, conservative treatment is sometimes successful. Case presentation Two patients were prenatally diagnosed, via ultrasonography, with left hydronephrosis. In each case, magnetic resonance imaging confirmed an ectopic ureterocele accompanying the left, completely duplicated ureter. Prophylactic antibiotics were administered and conservative treatment was started. Currently, one patient is 44 months old and the other is 49 months old; in neither patient has the ureterocele or hydronephrosis been exacerbated. Conclusion Patients with (i) a nonfunctional kidney, (ii) mild hydronephrosis or moderate vesicoureteral reflux, (iii) no bladder neck obstruction on urination, and (iv) a Churchill classification ≤Grade II (Churchill classification) may be able to select conservative treatment.

Abstract Background Uroterocele causes atony and stagnation in the ureter, thus predisposing the patient to stone formation. Multiple calculi in uroteroceles are common in adults but very rare in children. Case presentation We describe the case of a 3-year-old boy who presented with hematuria and was found to have multiple ureteral and ureterocele stones. The diagnosis was made during endoscopic lithotripsy. A holmium/yttrium–aluminum–garnet (Ho–YAG) laser was used to excise the uroterocele and for lithotripsy. Conclusions In appropriate cases, minimally invasive techniques, for example, Ho–YAG laser lithotripsy and ureterocele excision may be preferred.

Purpose: We aimed to determine the impact of de novo vesicoureteral reflux (VUR) on postoperative urinary tract infection (UTI) and renal function in pediatric patients with ureteroceles. Materials and Methods: We retrospectively reviewed the medical records of 34 patients (36 renal units) with ureteroceles that were treated endoscopically. Perioperative radiologic and clinical data regarding de novo VUR, UTI, and renal function were analyzed. Logistic regression analysis was used to identify factors that predicted unfavorable surgical outcomes, such as primary surgical failure, postoperative UTI, and deterioration of renal function. Results: Of the 36 renal units, 22 had a duplex system (61.1%). Preoperative VUR was noted in 9 units (25.0%), including 3 units without renal duplication. Endoscopic surgery successfully decompressed the ureterocele and hydronephrosis in 28 units (77.8%). De novo VUR developed in 18 renal units (50.0%) postoperatively. The absence or presence of de novo VUR was not related to unfavorable surgical outcomes in univariate or multivariate analyses. Even after selection for the 28 renal units without preoperative VUR, the occurrence of de novo VUR had no predictive value for unfavorable surgical outcomes. Moreover, among the 14 renal units without renal duplication, de novo VUR had no predictive value for any of these adverse outcomes. Conclusions: After endoscopic ureterocele puncture, de novo VUR is not significantly associated with postoperative UTI or deterioration in renal function in the long term. It may not, therefore, be necessary to reconstruct lower urinary tract routinely to correct de novo VUR after endoscopic puncture of the ureterocele.

Bilateral intravesical ureteroceles is a rare condition where both ureters terminally end in cystic dilations in the urinary bladder. Herein, a 31-year-old male patient presented with severe right flank pain and gross hematuria. Upon computed tomography imaging, a right ureterocele with an entrapped stone was revealed. Direct visualization also showed a smaller ureterocele at the left ureterovesical junction. Both ureteroceles were unroofed using rigid resectoscope with cold knife resulting in rapid bilateral efflux. The treatment was well tolerated with no known complications. Albeit uncommon, this case highlights the need to consider ureteroceles in adult patients with urinary tract symptoms.

L´urétérocèle est une dilatation pseudo-kystique de l´uretère terminal sous muqueux. C´est une uropathie malformative rare surtout si elle survient sur un uretère simplex. Il s´agit d´une étude rétrospective menée sur dix ans, de 12 dossiers de malades colligés au Service de Chirurgie Pédiatrique de l´Hôpital Fattouma Bourguiba de Monastir entre 2006 et 2016. L´âge moyen de nos malades est de 2,7 ans avec des limites allant de 7 jours à 11 ans, le sex ratio est de 1. Le tableau clinique a été dominé par la fièvre en rapport avec une infection urinaire haute. Le diagnostic a été posé essentiellement par l´échographie rénale et vésicale, l´urographie intraveineuse (UIV) et l´uréthro-cystographie rétrograde (UCR). L´urétérocèle était unilatéral dans 10 cas et bilatérale dans 2 cas soit un total de 14 cas d´urétérocèles. Tous ont été sur uretère simplex et ont été opérées par voie endoscopique. Aucun incident peropératoire n´a été noté. Les suites opératoires étaient simples. Une amélioration clinique et radiologique a été obtenue dans tous les cas. L´urétérocèle sur uretère simplex est une malformation urinaire très rare. Non diagnostiquée à temps, elle peut retentir sur le haut appareil. Le traitement endoscopique est une alternative séduisante avec des résultats satisfaisants.

Giant hydronephrosis in adults is a rare entity. It is defined as an extensive dilatation of the pyelocaliceal cavities occupying a large part of the abdominal cavity. Giant hydronephrosis is usually due to pelvi-ureteric junction obstruction and is usually diagnosed in children and infants. Ureterocele, which is a cystic dilatation of the terminal ureter, often drains the upper part of the kidney in patients with a duplex system. Massive hydronephrosis in a patient with duplex system and obstructive ureterocele was described by Aeron et al. in 2017. A thorough search of the major medical databases disclosed that no other cases have been reported since. We describe a second case of unilateral complete duplex system with ureterocele and massive hydronephrosis of the upper moiety in an adult man with intermittent abdominal pain associated with constipation and a decrease in appetite. The renal function of the left kidney was 8% of total function by radionuclide renal scan. The patient subsequently underwent left laparoscopic nephrectomy.

Introducción: el ureterocele es una dilatación quística del uréter submucoso distal, con prolapso dentro de la luz de la vejiga debido a un defecto muscular intrínseco en la pared ureteral. El objetivo del presente trabajo es describir un caso de ureterocele izquierdo ortotópico y la presencia de un cálculo hiperdenso en la unión ureterovesical del lado derecho. Caso clínico: paciente masculino de 48 años de edad con cuadro clínico de un mes de evolución, consistente en dolor lumbar de moderada intensidad, irradiado a flanco y testículo derecho, refiere disuria y polaquiuria. Se realizó urotomografía axial, la cual reportó un cálculo hiperdenso de aproximadamente 2 cm de diámetro en la unión ureterovesical del lado derecho, en el lado izquierdo se apreció ureterocele simple u ortotópico con apariencia de “cabeza de cobra”. Se optó por manejo quirúrgico como tratamiento definitivo, practicándose resección transuretral de ureterocele izquierdo y fragmentación con LithoClast del gran cálculo en el uréter derecho. Posteriormente se insertó catéter endoureteral doble jota. Conclusión: el ureterocele del adulto suele asociarse a sistemas ureterales únicos, completamente intravesicales u ortotópicos, el 18 % son bilaterales, porcentaje que es un poco mayor al 10%.Rev.cienc.biomed. 2015;6(2):360-363

To evaluate the efficacy of endoscopic meatotomy in the treatment of ureterocele in adults. A retrospective study of adult patients with ureterocele, treated between January 1987 and December 2014. In 47 patients, 55 intravesical ureteroceles were diagnosed and classified as 18 right, 21 left and eight bilateral (38%, 44% and 17% respectively). According to the Bruézière classification, 41 (75%) ureteroceles were type A and 14 (25%) others were type C. These ureteroceles were complicated by calculus formation in 22 cases, moderately dilated excretory pathways in 16 cases and both complications in a total of 9 cases. Four patients had a complicated ureterocele with pyelonephritis, one of which was emphysematous. The endoscopic treatment was performed in cases of complicated and/or symptomatic ureteroceles. Fifty one cases were treated by a "smiling mouth" meatotomy consisting in a transverse horizontal incision, with the treatment of any associated complication. The mean operative time was 35 minutes (10-90). The operative follow-up was uneventful in 42 patients and complications occurred in 5 patients (2 urinary retentions, 2 infectious complications and one hematuria). The mean duration of postoperative stay was 1-2 days. The mean follow-up was 15 months. Four patients developed vesicoureteral reflux and no stenosis was noted. The endoscopic incision of the ureteroceles seems today, after reviewing the results, to be a good treatment of adult ureterocele. It is a simple, minimally invasive and has a low morbidity rate.

Ureterocele is defined as a cystic dilatation of the terminal ureter. It is associated with obstructive uropathy, recurrent urinary tract infections, and acute/chronic renal injury. We present a case of a single system giant ureterocele at the bladder neck in an 8-month-old female infant that presented with an abdominal mass, pus discharge per urethra and failure to thrive. The aim is to highlight an unusual presentation of a giant ectopic left ureterocele in a female infant.

Ureterocele is dilatation of lower ureter at its entry into the urinary bladder. It is classified into the single or duplex system and acquired or congenital. Acquired type is rare and seen in adults. We report the case of a 23-year-old male presented with voiding lower urinary tract symptoms and intermittent flank pain. He had a history of frequent spontaneous stone passage with right colicky pain 2 years back. On ultrasonogram and magnetic resonance urogram, diagnosis was made as right renal hydronephrosis with hydroureter due to right side giant intravesical ureterocele. The patient was managed by endoscopic transurethral incision and excision of ureterocele. It is the first case ever reported in the literature, where in giant ureterocele was completely removed by total endoscopic approach.

Background: Renal agenesis is a congenital malformation that occurs due to the inhibition of metanephric blastema induction due to a decrease in ureteric bud activity. Although renal agenesis is not very rare, unilateral renal agenesis with ureterocele occurs rarely, and the coexistance of unilateral renal agenesis, ureterocele, and blind ended proximal ureter is very rare. Recently, we experienced a case of left renal agenesis with huge ureterocele, blind ended proximal ureter, and duplicated ureter on Computed tomography (CT) of a 17-year-old man who visited our emergency department with hematuria. Ureterocelectomy and nephrectomy were performed, and a translocation of seminal vesicle was also observed. This case is a very rare case, so we judged that it may be helpful in making treatment decisions in similar cases later. Case summary: A 17-year-old man without specific medical history visited our emergency department with hematuria and voiding difficulty. CT showed left ectopic kidney, megaureter and the blind ended proximal ureter. After ureterocelectomy and nephrectomy, pathological examination revealed seminal vesicles in the periphery of the kidney. After one year, the patient has no complications and no complaining symptoms complaints without any abnormal finding of follow up imaging test. Conclusions: This case report focuses on the treatment of renal agenesis with ureterocele, blind ended proximal ureter, duplicated megaureter and translocation of seminal vesicle. This rare case of treatment will be helpful in the determination of treatment for similar cases in the future. To establish standard treatment, data accumulation and well-designed studies are required.

Background: The available endoscopic techniques for ureterocele decompression include laser puncture (LP), electrosurgical incision (ES), and cold-knife incision. This systematic review was performed to compare the efficacy of LP versus ES techniques with special emphasis on de novo VUR. Methods: Four databases were systematically searched by the authors. The inclusion criteria were all comparative studies in which ureterocele decompression was performed by either LP or ES endoscopic techniques. Outcomes including the incidence of de novo VUR, the need for endoscopic retreatment of the ureterocele, and the need for secondary surgical procedures were studied. Risk ratios (RR) were calculated for all outcomes and the Mantel-Haenszel method was utilized for the estimation of pooled RR. The methodological quality was assessed by the Downs and Black scale. Results: Five studies were considered for systematic review, while four of them were included in the meta-analysis. Out of 202 children, 67 developed de novo VUR. Significantly lower rates of reflux were observed in the LP group vis-a-vis ES group (RR = 0.17, 95% CI 0.09 to 0.32, p < 0.00001). Endoscopic retreatment rates (n = 20) demonstrated no significant difference among the two patient groups (RR = 0.66, 95% CI 0.26–1.68, p = 0.38). A total of 46 secondary procedures were performed in 170 children, mostly ureteral re-implantations, with a significantly lower need of secondary surgeries following LP versus ES (RR = 0.26, 95% CI 0.13–0.49, p < 0.0001). The risk of bias in the included studies was low-to-moderate. Conclusions: When compared to the ES technique, the LP technique is associated with a significantly low incidence of de novo VUR and requirement for secondary surgeries (particularly anti-reflux surgeries). Endoscopic retreatment rates showed no significant difference between the two techniques. However, due to the moderate risk of bias in two out of four included studies, randomized controlled trials are needed in the future.

Objective: We reviewed the result of upper and lower tract approaches in duplex collecting systems at Siriraj Hospital between January 2011 and January 2017, focusing on reoperation rate and postoperative urinary tract infection. Methods: We analyzed the medical records of 57 patients with duplex kidneys, ectopic ureter and ureterocele. 45 patients were treated with open surgical therapy including upper tract approach which consisted of upper pole nephrectomy and ureteropyelostomy, and lower tract approach which was common sheath reimplantation. Information included age at operation, gender, ectopic ureter and ureterocele location, vesicoureteral reflux (VUR), hydrohephrosis status and presenting symptoms. Results: Upper tract approach was performed in 23 patients, 3 patients were reoperated because of persistent ureterocele in 2 cases and VUR in 1 case (13.6%, p = 0.233). One was lost to follow-up. Among 22 patients who underwent lower tract approach, no patient required second operation with antibiotic prophylaxis. Conclusion: In the absence of ureterocele and VUR, upper tract approach surgery appears to be successful treatment of duplex kidneys. When compared with upper tract approach, the lower tract approach surgery is more effective for open surgical therapy in duplex kidneys if sample size increases.

Introduction: Ureterocelemay cause severe pyelo-ureteral obstruction with afebrile urinary tract infections in infants and children. Early decompressive treatment is advocated to reduce the risk of related renal and urinary tract damage. Endoscopic techniques of incision have been offered utilizing diathermic electrode. We adopted laser energy to release the obstruction of the ureterocele and reduce the need of further surgery. Our technique is described and results are presented, compared with a group of matched patients treated by diathermic energy.Materials and methods: Decompression was performed by endoscopic multiple punctures at the basis of the ureterocele. Holmium YAG Laser was utilized with 0.5–0.8 joule energy, through 8–9.8F cystoscope under general anesthesia. The control group received ureterocele incision by diathermic energy through pediatric resettoscope. Foley indwelling catheter was removed after 18–24 h. Renal ultrasound was performed at 1, 3, 6, and 12 months follow-up. Voiding cysto-urethrogram and radionuclide renal scan were done at 6–18 months in selected cases. Statistical analysis was utilized for data evaluation.Results: From January 2012 to December 2017, 64 endoscopic procedures were performed: 49 were ectopic and 15 orthotopicureteroceles. Fifty-three were in duplex systems, mostly ectopic. Mean age at endoscopy was 6.3 months (1–168). Immediate decompression of the ureterocele was obtained, but in five cases (8%) a second endoscopic puncture was necessary at 6–18 months follow-up for recurrent dilatation. Urinary tract infections and de novo refluxes occurred in 23.4 and 29.7% in the study group, compared to 38.5 and 61.5% in the 26 controls (p < 0.05). Further surgery was required in 12 patients (18%) at 1–5 years follow-up (10 in ectopic ureteroceles with duplex systems): seven ureteral reimplantation for reflux, five laparoscopic hemy-nephro-ureterectomy. Orthotopic ureteroceceles had better outcome. Secondary surgery was necessary in 13 patients (50.0%) of control group (p < 0.05).Conclusions: Early endoscopic decompression should be considered first line treatment of obstructing ureterocele in infants and children. Multiple punctures at the basis of the ureterocele, performed by low laser energy, is resulted a really minimally invasive treatment, providing immediate decompression of the upper urinary tract, and reducing the risk of further aggressive surgery.

Aim: To assess of the role of renal ultrasonography (US) and DMSA renal scintigraphy in the prediction of irreversible histological lesions of the upper pole in duplex system. Methods: A prospective cohort study based on data collected between 2005 and 2012 at our institution. The cohort consisted of 23 patients with ureteroceles and 28 patients with ectopic ureters who underwent upper pole nephrectomy. Preoperative recordings from ultrasound and nuclear renal scans were compared with the histological findings. Histological irreversible lesions were defined as the presence of dysplasia and/or severe chronic interstitial nephritis (CIN) in ≥ 90% of the specimen. ROC (Receiver Operating Characteristic) curves were used to investigate thresholds in order to identify irreversible lesions using various differential functions. The histology was correlated with the results of imaging. Results: Pathological findings were found in all histological samples. Histological lesions were irreversible in 20/23 patients (87.0%) with ureteroceles and in 14/28 patients (50.0%) with ectopic ureters. The model is able to predict irreversible lesions if an upper pole differential function is ≤ 3% in patients with ureteroceles, and ≤ 2% in the presence of ectopic ureters. Weak association between parenchymal thinning on ultrasonography and irreversible lesions was found in patients with ectopic ureters. Conclusion: DMSA renal scintigraphy provides a useful tool for the prediction of irreversible lesions in the upper pole. Low differential function (≤ 3% and ≤ 2%, respectively) indicates irreversible lesions, favoring heminephrectomy. Higher differential function indicates greater remaining biological potential of the parenchyma, favoring reconstruction of the upper pole.

The article describes the main aspects of clinical manifestations, diagnosis and treatment of ureterocele in conjunction with urolithiasis with a sample of clinical case.

A 44-year-old woman underwent endoscopic incision of a right simple ureterocele with hydronephrosis discovered during gynecological assessment for stress urinary incontinence with Stage I cystocele. At the postoperative visits, she has reported a persistent flap of mucosa coming out from her urethra protruding in the vagina despite manual reduction. An endoscopic resection of the mucosa flap was programmed. After 24 months, she was asymptomatic with no history of renal colic or urinary tract infection. In patients with a history of pelvic organ prolapse, the resection of the ureterocele in the first instance may be the optimal choice.

L'hydronéphrose géante est définie comme une importante dilatation des cavités pyélo-calicielles occupant une grande partie de la cavité abdominale, ou une dilatation contenant plus d'un litre d'urine débordant la ligne médiane. Elle est dûe le plus souvent à un syndrome de la jonction pyélo-urétérale. L'obstruction par urétérocèle compliquée de lithiase est une cause très rare. Nous rapportons le cas d'un patient de 45 ans, ayant comme antécédent des douleurs lombaires droites non explorées, qui a consulté pour une masse abdominale évoluant depuis quelques années associée à une constipation intermittente. L'examen clinique a objectivé une distension abdominale asymétrique avec une matité débordant la ligne médiane. L'échographie a montré une formation liquidienne multi-cloisonnée occupant toute la région abdomino-pelvienne droite et refoulant les structures digestives. L'uroscanner a dévoilé une énorme dilatation urétéro-pyélo-calicielle droite (pyelon mesurant 15,2cm) laminant complètement le parenchyme rénal avec absence d'excrétion du produit de contraste, en amont d'une urétérocèle compliquée d'un calcul de 2cm. Une néphro-urétérectomie a été réalisée par laparotomie et les suites post opératoires ont été simples.

We present a case of a 54-year-old woman with a left-sided complete duplication of the ureter. The upper moiety drains in the proximal third of the vagina, which results in an ureterocele and urinary incontinence. The ureteral orifice of lower moiety ureter was normal. Duplication of the ureters with distal, infra-sphincteric, vaginal implantation is an uncommon congenital anomaly and a rarely seen entity in adulthood as a cause of urinary incontinence. MR colpocystodefecography showed an ureterocele in between the bladder and the rectum. Computed-tomography showed the duplicated ureters and ectopic ureter with proximal implantation on the renal upper pole and distal implantation on the proximal third of the vagina.

Objective: We reviewed the result of upper and lower tract approaches in duplex collecting systems at Siriraj Hospital between January 2011 and January 2017, focusing on reoperation rate and postoperative urinary tract infection. Methods: We analyzed the medical records of 57 patients with duplex kidneys, ectopic ureter, and ureterocele. 45 patients were treated with open surgical therapy including upper tract approach which consisted of upper pole nephrectomy and ureteropyelostomy, and lower tract approach which was common sheath reimplantation. Information included age at operation, gender, ectopic ureter and ureterocele location, vesicoureteral reflux (VUR), hydrohephrosis status and presenting symptoms. Results: Upper tract approach was performed in 23 patients, 3 patients were reoperated because of persistent ureterocele in 2 cases and VUR in 1 case (13.6 %, p = 0.233). One was lost to follow-up. Among 22 patients who underwent lower tract approach, no patient required the second operation with antibiotic prophylaxis. Conclusion: In the absence of ureterocele and VUR, upper tract approach surgery appears to be successful treatment of duplex kidneys. When compared with upper tract approach, the lower tract approach surgery is more effective for open surgical therapy in duplex kidneys if sample size increases.

Introduction: ureterocele is a cystic dilatation of distal submucosal ureter, with prolapse into the bladder`s lumen caused by the intrinsic defect in the ureteral muscle wall. The purpose of this report is to describe a case of left orthotopic ureterocele and the presence of a great right bladder stone. Case record: a 48 years old man had a moderate lumbar pain radiating to the right flank and testicle with clinical profile of a month of evolution. It was associated with dysuria and increased urinary frequency. Axial urotomography reported a great calculi bladder with approximate 2 cm of diameter in the right vesicoureteral junction and on the left side ureterocele single or orthotopic appearance seen with “cobra head”. Surgical management was choosen as definitive treatment; transurethral resection of left ureterocele was practiced with LithoClast and fragmentation of large calculi on the right ureter. Subsequently, endoureteral double J catheter was inserted. Conclusion: the adult ureterocele usually associated with ureteral unique systems, orthotopic or fully intravesical, 18% are bilateral, being little more than 10%. Rev. cienc.biomed. 2015;6(2):360-363 KEYWORDS Ureterocele; Urology; Lithiasis.

Ectopic ureter and ureterocele are rare congenital anomalies. As such, are seldom encountered incidentally during urologic surgery. We present a case illustrating an unforeseen encounter of an ectopic ureter with an associated ureterocele during a robotic assisted laparoscopic prostatectomy (RALP) and the surgical technique used to adapt to the anatomical variation.

Objective: Multicystic dysplastic kidney (MCDK) is a developmental anomaly believed to be a consequence of either early in utero urinary tract obstruction or failure of union between the ureteric bud and the metanephric blastema. Concomitant finding of MCDK and ipsilateral obstructive ureterocele may further support the obstructive theory. We aimed to explore the possible linkage between MCDK and ipsilateral obstructive ureterocele. Materials and Methods: Ultrasonographic imaging and voiding cystourethrography (VCUG) of children diagnosed with MCDK were retrospectively reviewed. Results: A total of 28 children with MCDK were included, all of whom underwent ultrasonography and 16 underwent VCUG. Ten of the 16 children (62%) who underwent VCUG had vesicoureteral reflux, none of which was to the MCDK. Twenty of 28 children (71%) had MCDK replacing the entire kidney, among whom seven (35%) had an ipsilateral ureterocele on bladder imaging. Eight of 28 children (29%) had segmental disease, all involving the upper pole of a duplex kidney (right, 4; left, 4). All four left-sided kidneys with segmental MCDKs had an associated ipsilateral ureterocele. Conclusion: Our data highlight the fact that MCDK is frequently identified with a concomitant finding of an ipsilateral ureterocele, which should be carefully sought whenever MCDK is identified. The reported association strongly supports the theory of MCDK development as a result of an in utero urinary tract obstruction.

Un ureterocele es una dilatación del extremo distal del uréter que se produce en etapa fetal. La incidencia varía según las series entre 1:500-4000 pacientes, predominantemente en niñas. Se presenta el caso de una paciente de color de piel blanca, 50 años de edad, con antecedentes de infecciones repetidas del tracto urinario que acudió a médico de familia porque desde hacía varios meses su cuadro se había exacerbado con varios episodios de disuria, polaquiuria y urgencia miccional. Se recomendó realizar ultrasonido abdominal y acudió al Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, donde mediante estudio ultrasonográfico abdominal con múltiples cortes se observó una imagen mixta hacia la región media del riñón derecho. En el riñón izquierdo se observó ureteropielocaliectasia con buena diferenciación córtico medular y el uréter dilatado hasta su entrada a la vejiga como imagen ecolúcida redondeada de aspecto quístico intravesical. Por ser un hallazgo poco común se decidió la presentación del caso.

Un ureterocele es una dilatación del extremo distal del uréter que se produce en etapa fetal. La incidencia varía según las series entre 1:500-4000 pacientes, predominantemente en niñas. Se presenta el caso de una paciente de color de piel blanca, 50 años de edad, con antecedentes de infecciones repetidas del tracto urinario que acudió a médico de familia porque desde hacía varios meses su cuadro se había exacerbado con varios episodios de disuria, polaquiuria y urgencia miccional. Se recomendó realizar ultrasonido abdominal y acudió al Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos, donde mediante estudio ultrasonográfico abdominal con múltiples cortes se observó una imagen mixta hacia la región media del riñón derecho. En el riñón izquierdo se observó ureteropielocaliectasia con buena diferenciación córtico medular y el uréter dilatado hasta su entrada a la vejiga como imagen ecolúcida redondeada de aspecto quístico intravesical. Por ser un hallazgo poco común se decidió la presentación del caso.

Relataram-se o quadro clínico, o diagnóstico, o tratamento e o acompanhamento de um cão com ureterocele ectópica e hidronefrose/hidroureter associados. Após as informações obtidas nos exames laboratoriais e de diagnóstico por imagem, o animal foi submetido à ureterocelectomia e à neoureterostomia. O cão apresentou evolução favorável após a conduta terapêutica. Apesar de pouco frequente, a ureterocele deve ser considerada como diagnóstico diferencial em animais jovens com histórico de incontinência urinária.