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Highlights • Ureterocele is rare especially with collecting system duplication in the nonorthotopic (extravesical) position in adult. • Ureterocele has a variety of clinical manifestations and complications. • Endoscopic treatment was performed to decompress hydroureteronephrosis. • In this case, laparoscopy heminephrectomy is needed due to dysfunctional uppers moiety. • Renal scintigraphy is a gold standard to assess function in the duplex kidney., Introduction Ureteroceles is a developmental anomaly with cystic dilation of the distal aspect of the ureter and are often associated with some urological anomaly such as a duplicated system or stenotic ureteric orifice. Presentation of case This study reports an ectopic ureterocele in duplication of collecting system associated with double ureters and ureteral ectopia in a woman aged 24 years with minor flank pain. Cystoscopy deroofing of the ureterocele performed and followed by secondary surgery laparoscopic heminephrectomy. Discussion Ureteroceles have various clinical manifestations and complications. Treatment for ureterocele depends on age, type of the ureterocele, obstruction to the draining system, and complications. No single method is sufficient for all cases, and management must be individualized. Endoscopic treatment has gradually broadened as a safe, minimally invasive, and effective procedure, but there is no consensus on its effectiveness for treating ectopic ureterocele. However, it is reported that 50–80% of cases after initial endoscopic treatment require secondary surgery. Conclusions Ureterocele is reported rarely in adults, especially with duplication of the collection system in the nonorthotopic (extravesical) position in women. Cystoscopy deroofing of the ureterocele can be performed to decompress the hydroureteronephrosis, and laparoscopic heminephrectomy can be performed due to dysfunctional uppers moiety. Long-term follow-up is required to monitor renal function, symptoms, and occurrence of vesicoureteric reflux.

Introduction: Ureterocele is a rare urogenital malformation. The treatment is variable and complicated as it depends on several factors. The aim of this study was to evaluate the management and outcomes of children with ureterocele and to compare single system and duplex system ureteroceles. Materials and Methods: A retrospective study was conducted and all patients with ureterocele operated from January 1992 to December 2018 were included. The records of those included were assessed, and a detailed case record sheet was filled. The outcome parameters assessed were the persistence of symptoms and additional surgical procedure performed. Results: Forty-seven patients (28 boys and 19 girls) with a median age of presentation of 21 months were included. Four patients had bilateral ureterocele. Overall, 51 renal units with ureterocele were studied. Twenty renal units of the 31 renal units with duplex system underwent cystoscopic decompression, and of these, 8 (40%) needed a second procedure. Fourteen renal units of the remaining 20 renal units with single system underwent cystoscopy and decompression, and of these, 1 (7%) required another procedure (P = 0.024). Sixteen renal units had ectopic ureterocele, of which 9 (56%) underwent heminephrectomy/nephrectomy. Intravesical ureterocele was present in 35 renal units, of which only 2 (5.7%) underwent nephrectomy or heminephrectomy (P < 0.001). Conclusion: Duplex system ureteroceles are more likely to require a second procedure following an endoscopic puncture. Units with ectopic ureterocele were more likely to need nephrectomy.

The article discusses a case of 4-year-old patient with a bilateral obstructive megaureter of a non-functioning left kidney and with the opening of this kidney ureter into the urethra with extravasal location of a giant ureterocele. The malformation of the urinary system was accompanied by a comorbid disease of bronchopulmonary system in the form of tuberculosis of the lungs and intra-thoracic lymph nodes. At the age of one month, due to decompensation of the only functioning right kidney, urine was withdrawn by applying a ureterostomy. Later, a proximal lateral cutaneous ureterostomy was put because of social reasons (mother refused of her baby). In two months, the next step was performed - a ureterocystoneostomy by the Cohen’s antireflux technique. After a long-term treatment for tuberculosis in clinics of Tver and St. Petersburg, at the age of 4, the girl was operated on at the first surgical department at St-Petersburg State Pediatric Medical University. Laparoscopic nephroureterectomy on the left with conversion to lower-middle laparotomy and resection of the terminal part of the left ureter with a giant ectopic ureterocele as well as closure of the ureterocutaneostomy on the right were performed. After stabilization, the child was transferred to a children’s boarding school in Tver, and currently is supervised by pediatric urologists and TB specialists.

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.

Ectopic ureteroceles is sometimes noted in children as an incidental finding in antenatal ultrasonography results or because of symptoms related to a urinary tract infection. In contrast, it is rarely noted in adults, with only 18 cases in Japan presented in literature. We report here a 30-year-old adult male with an ectopic ureterocele discovered due to urination difficulty. The patient noted a poor urine stream and macroscopic hematuria after exercise, and over time needed manual compression on the lower abdomen for urination. Computed tomography results revealed a 35 mm right ureterocele containing a 7.0 mm stone. Cystoscopy showed the ureterocele protruding into the prostatic urethra, which was thought to be the cause of urination difficulty. Transurethral resection of the ureterocele and lithotripsy for the stone were performed. The right ureteral orifice was not visualized during the operation. Resection was performed from the bladder neck side so that the ureterocele wall did not interfere with urination and the calculus was crushed with a pneumatic lithotripter (LithoClast®). Urination difficulty was improved following the procedures. Urinary cystourethrography performed two weeks postoperatively confirmed no vesicoureteral reflux. No symptoms of dysuria or fever were noted at a follow-up visit two months after the operation.

Objective: Ureterocele in a duplex system is rare and commonly presented with urinary tract infection at neonatal age, infant or childhood. Symptomatic ureterocele in reproductive-age is a diagnostic challenge and should be highly awarded to avoid miss-diagnosis. Case report: An adolescent girl with right ectopic ureterocele presented as acute abdomen that mimicked ovarian torsion received emergent laparoscopic surgery. Right ureterocele was identified and excised. Computed tomography later showed bilateral renal duplications with visible renal parenchyma and upper ureters. Recurrent abdominal pain with pelvic abscess occurred 10 days after surgery. Laparoscopic right partial nephrectomy of the upper moiety and resection of the residual ureterocele was performed. Cystoscopy showed absence of intravesical ureterocele and her symptoms were completely resolved after surgery. Conclusion: Infected ureterocele in a duplex system is a rare condition and should be kept in mind as differential diagnosis. Keywords: Acute abdomen, Ureterocele, Duplex system

Paraurethral cysts are rare. Vaginal wall inclusion cyst, scene gland abscess, gartner duct cyst, ectopic ureterocele, periurethral fibrosis, vaginal leomyoma, urethral or vaginal neoplasm should be considered in differential diagnosis. The patient may have irritative symptoms (urinary urgency, frequent and painful urination), obstructive voiding symptoms or urinary incontinence. Physical examination is extremely important in diagnosis. Complete removal of the cyst is an effective treatment method, the risk of recurrence is low. Case report We present a 13-year-old girl with an interlabial ovoid mass with perineal pain. Physical examination revealed normal except for a 3*3 cm cystic formation in the vestibulum. There was no urinary obstruction associated. There was unremarkable in her history. No additional pathology was found in the abdominal and urinary ultrasonograhy. Urethral catheterisation was performed under anaesthesia had identified the urethral opening location, and displacement of the meatus was observed to be on the left lateral wall of the mass ( Fig. 1 ). Paraurethral cyst was totally excised ( Fig. 2 ).

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.

Made available in DSpace on 2021-06-25T12:32:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-01-01 Background: Ureteroceles are cystic dilatations of the terminal ureter and is a rare diagnosed condition in dogs. They can be classified as orthotopic when it is entirely within the bladder and the ureteral orifice emerges normally or ectopic if the ureteral orifice is not in the normal position in the trigone. Orthotopic are usually clinically silent. Ureterocele can contribute to lower urinary tract disease leading to infections and loss of the renal function. As long as this injury can arise slowly, it might be underdiagnosed in companion animals. This case aims to report a case of a bitch with diagnosed symptomatic orthotopic ureterocele efficacious surgical treatment. Case: A 5-month-old female mixed breed was referred to the veterinary hospital, with a major complaint of urinary incontinence since the birth date after the first attendance in a colleague who have suspected of ureterocele considering ultrasound report of a vesicle of 1.4 x 1.5 cm in lefts ureter bladder's insertion topography with ipsilateral hydroureter and renal dilatation. Beside the urinary dysfunction, the animal presented good general status and normal vital signs. Complete blood count and biochemical analysis were within normal ranges. A new ultrasound exam and Computerized Urotomography with contrast gave the definitive diagnosis of left orthotopic ureterocele with twisted hydroureter (proximal 1.29 cm and distally 0.98 cm) and hydronephrosis (3.32 cm). The marsupialization was chosen scientifically based to correct the ureterocele and the patient presented good general condition since then with prompt improvement of clinical signs. The patient was submitted to serial image exams in six weeks following up to check the consequent urinary tract dilatation from the previous disease regression. After the last follow up animal received hospital discharge and was assessed twice in four months with normal measures of the urinary tract. Discussion: Different from the most common insert point of this injury, this case report presents an orthotopic ureterocele which due to the clinical signals, could be diagnosed differently from the literature who have described most often ectopic or asymptomatic events. Corroborating with usual development of uretero vesical junction obstruction described, this patient also advanced to hydroureter, hydronephrosis and kidney parenchymal loss. Due to being uncommon in small animal routine, diagnosis and therapeutic recommendations are based on few veterinarian and mainly human data. The gold-standard diagnostic method is excretory urethrocystography with an intra-bladder image called cobra-head or a contrast cystic fill defect. When ectopic ureterocele is suspected, intra-venous contrast urography or Computerized urotomography are a thrustful choice. Surgical treatment is indicated in symptomatic and obstructive ureterocele. The planning was based in urotomography diagnosis of unilateral orthotopic left ureterocele, marsupialization technique was performed. Two days after the procedure, the patient returned maintaining the total enhancement of incontinence. During the image follow up made after the surgery was observed decrease of the dilatations and improvement of renal medullary cortical ratio. This case report raises the importance of counting uncommon diseases as differential diagnosis in the veterinarian routine. Also, the use of the correct image approach can lead to the definitive diagnosis and treatment. UNESP, Sch Vet Med & Anim Sci FMVZ, Vet Surg & Anim Reprod Fac, Botucatu, SP, Brazil UNESP, Sch Vet Med & Anim Sci FMVZ, Vet Surg & Anim Reprod Fac, Botucatu, SP, Brazil

Introduction: Pyelonephritis is a urinary tract infection that can frequently be complicated by anatomical abnormalities such as in ectopic ureteroceles, pathologies which are rare in the literature. Case Report: A 23-year-old woman with a clinical history, physical and laboratory examinations compatible with pyelonephritis was admitted. Ultrasonography revealed a ureterocele and hydronephrosis of the upper collecting system of the left kidney. We evoked a complicated pyelonephritis and the patient underwent a computed tomography (CT) scan that confirmed bilateral pyelocalyceal and ureteral duplicity, pyonephrosis, and implantation of the upper ureter of the left kidney into the vaginal dome, forming a left ureterocele. The patient was placed on antibiotics and the ureterocele was drained through the vaginal canal. After twelve days of hospitalization, she underwent an open partial nephrectomy of the upper portion of the left kidney. On the third postoperative day, she was asymptomatic and was discharged. Conclusion: Despite the typical clinical picture of complicated pyelonephritis, this case stands out for the unusual and challenging anatomical findings, such as the pyelocalyceal bilateral duplicity and a rare infected ectopic ureterocele with vagina implantation. These challenging findings required transvaginal drainage and heminephrectomy, what shows that anatomical rare abnormalities can be hidden in a typical clinical presentation of pyelonephritis and demand an intense radiologic investigation and unusual treatments.

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.

Ureterocele is a relatively common malformation of the urinary system in children; however, the ureterocele prolapse through the urethra is an extremely rare presentation. Urological nuclear magnetic resonance is the test of choice for definitive diagnosis. Initial treatment of a prolapsed ureterocele involves decompression of the mass. We report the case of a 7-month-old infant with duplication of the collecting system and right ectopic ureterocele appearing as a vulvar mass.

Duplication of the ureters is a common anomaly and is frequently encountered by radiologists. Duplication may be either complete or incomplete and is often accompanied by various complications. Incomplete duplication is most often associated with ureteroureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney. Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral insertion, all of which are more common in girls than in boys. Vesicoureteral reflux affects the lower pole

We report on the observation of a 30-month-old female newborn that was treated for a urinary infection. The medical imaging revealed the existence of a right double system ureterocele with vesicorenal reflux on the ureter of the upper pyelon and a bifid left ureter. The treatment consisted in an ureterocelectomy, a reimplantation of the two right ureters and a repair of the vesical floor. The external drainage of the upper pyelon allowed us to make sure of its functionality that was about 15% of the full renal function. The post-op follow-ups have been simple and thirteen months later, the newborn is doing well and does not present any sign of urinary infection.

Ectopic ureteroceles are one of the most common human urinary tract anomalies. They tend to be recognized and treated in early childhood, especially when they have prolapsed. In most cases surgical therapy is inevitable. In this case report, however, we present the unusual case of a 26-year-old woman suffering from a prolapsed cecoureterocele without any known history of an ectopic ureterocele so far. She was successfully treated without the need for a surgical procedure.

Paraurethral cysts or Skene’s duct cysts are a rare cause of inter labial mass in a neonate. The precise etiology of paraurethral cyst is unknown. A thorough urologic evaluation was required to differentiate it from an ectopic ureterocele, urethrocele, urethral diverticula, and benign or malignant urethral and paraurethral tumors. A day 7 female baby was brought to us with history of asymptomatic introital mass noticed at day 4 of life. It was displacing urethra supero-laterally to the left and the vagina inferiorly with normal cystogenitoscopy. Simple excision of cyst was done uneventfully. Though asymptomatic, because of cosmetic and parental anxiety, and for a definitive diagnosis, simple excision of cyst was done uneventfully without recurrence.

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. The clinical features, diagnosis, treatment and monitoring of a dog with an ectopic ureterocele and concomitant hydronephrosis/hydroureter were reported. After the information obtained in laboratory tests and imaging diagnosis, the animal was submitted to ureterocelectomy and neoureterostomy. The dog presented a favorable evolution after the therapy. Although infrequent, the ureterocele should be considered a differential diagnosis in young animals with history of urinary incontinence.

Objective: We analyzed our experience with nephrectomy and upper pole heminephrectomy combined with subtotal ureterectomy to determine the incidence of the problems associated with the distal ureteral stump. Materials and Methods: The records of 48 children who underwent nephrectomy or upper pole heminephrectomy with subtotal ureterectomy for a poorly functioning kidney were reviewed. Results: No patient who underwent nephrectomy for a poorly functioning single-system kidney required secondary surgery. No secondary surgery was required in any patient who underwent upper pole heminephrectomy for ectopic ureter, while secondary surgery was required in five of 17 patients (29%) who underwent upper pole heminephrectomy for ectopic ureterocele. All five patients presented with recurrent febrile urinary tract infection after upper pole heminephrectomy. They also had reflux into the ipsilateral lower moiety, contralateral kidney, or distal ureteral stump. Our results and data from other reports suggest that recurrent urinary tract infections after upper pole heminephrectomy were treatment outcomes based on the initial surgical approach to ectopic ureterocele rather than isolated problems associated with the distal ureteral stump. Conclusion: We consider that total ureterectomy is unnecessary at the time of nephrectomy or heminephrectomy for a poorly functioning kidney because the distal ureteral stump rarely causes a problem.

Bilateral duplex system with ureteroceles is one of the rarest entities in urology. Incontinence in children is a frequently encountered problem; most often the cause is functional. Less often the cause could be structural such as an ectopic ureter; however bilateral complete renal duplex with bilateral ectopic ureteroceles as a cause of incontinence is even rarer. We herein report a case of bilateral duplex system ectopic ureters with ureteroceles with persistent urinary incontinence despite right upper heminephroureterectomy due to overlooked left dysplastic moiety. This article highlights the importance of thorough clinical and radiological evaluation of contralateral draining system when examining a case of unilateral complete renal duplex system with ureteral ectopia and/or ectopic ureterocele, especially in females to avoid delayed diagnosis.

We wish to highlight the importance of multi-modality imaging in patients with renal agenesis who may present with lower urinary tract obstruction symptoms. Our case features a rare entity comprising three associated urinary tract anomalies, namely, a blind ending ureter, ectopic uretrocele, and ipsilateral renal agenesis, in a 20-year-old male patient.

PURPOSE: We determined the prevalence, anatomical variants and coexisting complications of duplex collecting systems in children with a history of UTI. Additionally, we compared the prevalence and severity of the coexisting anomalies with those found in single systems. MATERIALS AND METHODS: We reviewed the records of children younger than 6 years who were evaluated following a first UTI during a 9-year period to identify those with duplex systems. Children without duplication anomalies comprised the control group. RESULTS: Of 774 evaluated children 63 (8%), more commonly females than males, had duplex systems. CDS were as common as IDS. VUR was the most commonly associated anomaly, with a higher prevalence in CDS (66%) and IDS (47%) compared to single systems (26%, p

26歳男.サッカーで左背部打撲後, 腹部痛が出現した.CTで後腹膜腔に巨大な嚢胞性腫瘤とその内部に尿管と考えられる索状物を認めた.膀胱鏡検査では左尿道管～膀胱頸部の膨隆と前立腺部尿道の膨隆下端に尿管口を認めた.RPを施行したところ, 左上半腎所属尿管による膀胱への圧排像を認め, 左上半腎所属尿管は外側に圧排偏位し, 水腎症を呈していた.カテーテルを留置し保存的に経過観察した.ドレナージにより腎機能は改善した.その後, 左上半腎所属尿管に対して経尿道的異所性尿管瘤切開術を施行した.術後1ヵ月, VURを認めるものの左水腎症は改善し, 術後7ヵ月の現在, 排尿障害, 尿路感染は認めていない, We report a case of ectopic ureterocele in a male adult found during examination of a traumatic injury. A 26-year-old man sustained a blow to his left back during a football game and was admitted to the hospital with a complaint of abdominal pain. The computed tomographic scan showed a huge cystic mass in the retroperitoneum. A cystoscope revealed a large bulge from the left ureteral orifice to the bladder neck and another ureteral orifice distal to the bulge. Retrograde pyelography revealed an ectopic ureterocele showing a complete duplication, a lateral deviation of the left ureter and a bladder deviation to the right. An ectopic ureteral orifice was opening in the posterior urethra. An ureteral catheter inserted into this orifice revealed a dilated left ureter from the upper half of the kidney. Because the function of left upper of kidney was maintained, a transurethral incision was performed. Vesicoureteral reflux remained, but the postoperative course was uneventful. We discuss 11 cases of ectopic ureterocele in male adults including this case.

5歳女児.1歳2ヵ月より尿路感染症を繰り返し, 右異所性尿管瘤と診断され保存的に経過観察されていた.IVP, DMSA腎シンチで瘤所属右上半腎は無機能で下半腎に国際分類III度の膀胱尿管逆流症を認めた.1998年8月13日, 右後腹膜鏡下半腎摘出術及び瘤切除, 右下半腎逆流防止術を施行した.術後経過は良好で, 術後3ヵ月目のVCGでも逆流は消失し, 腎機能も良好であった.小児における腹腔鏡下半腎摘出術は現在迄に15例の報告があるが, 後腹膜アプローチは本症例が初めてである, A 5-year-old girl with a history of recurrent urinary tract infection since the age of 14 months was diagnosed as having a right duplicated urinary collecting system with the upper ureter ectopically opening in the urethra. She underwent retroperitoneoscopic heminephrectomy for a right dysplastic kidney and open ureterocelectomy and reimplantation of the refluxing lower ureter via Pfannenstiel incision. She survived the procedure without serious complications and resumed normal daily activities by day 6. To the best of our knowledge, this case is the 16th case of laparoscopic heminephrectomy for pediatric patients and the first case treated by the retroperitoneal approach in the English literature.

High-resolution magnetic resonance (MR) imaging with phased-array pelvic and endorectal coils has dramatically enhanced the ability to visualize abnormalities of the female urethra and periurethral tissues. These include developmental abnormalities (eg, urethral duplication, ectopic ureterocele), benign processes (eg, urethral diverticulum, caruncle, leiomyoma, trauma, and fistula; stress incontinence; paravaginal cyst), and malignant processes (eg, primary urethral carcinoma, secondary urethral malignancies). High-resolution MR imaging can be used to assess complications such as fistula formation and periurethral abscess, localize various entities, exclude pathologic processes whose presence could lead to an incorrect diagnosis, differentiate processes that might be confused at physical examination, and contribute to surgical planning and facilitate surgical correction.

Duplication of the ureters is a common anomaly and is frequently encountered by radiologists. Duplication may be either complete or incomplete and is often accompanied by various complications. Incomplete duplication is most often associated with ureteroureteral reflux or ureteropelvic junction obstruction of the lower pole of the kidney. Complete duplication is most often associated with vesicoureteral reflux, ectopic ureterocele, or ectopic ureteral insertion, all of which are more common in girls than in boys. Vesicoureteral reflux affects the lower pole and can be outgrown, as in nonduplicated systems. Ectopic ureterocele and ectopic ureteral insertion affect the upper pole. The ectopic ureterocele produces a filling defect of variable size in the bladder; it can be identified with contrast material studies or ultrasound. Ectopic ureters may function poorly, be difficult to detect, and cause enuresis in girls. A fourth complication, ureteropelvic junction obstruction, occurs only in the lower pole and is seen in more boys than girls. Anatomic variants or anomalies as well as suboptimal imaging techniques can either simulate or obscure duplication, making diagnosis difficult. However, familiarity with the embryology of duplication and an awareness of the potential pitfalls of excretory urography and voiding cystourethrography will foster an understanding of the varied appearances and associated complications of both incomplete and complete duplication.

A 6-month-old hyponatremic female with failure to thrive had low urinary sodium concentration. Renal sonography revealed a duplex left collecting system with obstruction of the upper moiety as a blind-ended ectopic ureterocele extending to the bladder base. The echogenicity of the urine within the upper pole system was greater than the bladder contents. We believed that low urinary sodium concentration represented a false negative test and the salt loss by the obstructed left kidney was entrapped in the upper pole collecting system. Prior to ureterocele repair, intraoperative bladder and ureterocele aspirates revealed discordant sodium concentration supporting the sonographic conclusion.

WOS: 000298720200042, Retrograde ejaculation is an uncommon cause of infertility. It may be congenital, acquired or idiopathic. It can be very rarely a consequence of an ectopic ureterocele. Herein, we present an infertile patient with retrograde ejaculation due to ectopic ureterocele and emphasize the role of magnetic resonance imaging in diagnosis. Only three similar cases have been reported in the literature. The pathogenesis of retrograde ejaculation due to ureterocele remains unclear. It is postulated that dilated ectopic ureter in some way affected the development of the innervation of the bladder neck. Ectopic ureterocele should be kept in mind in the differential diagnosis of patients with retrograde ejaculation.

Two patients with complete duplex kidney accompanied by ectopic ureterocele and vesicoureteral reflux (VUR) had repeated episodes of refractory urinary tract infection. One patient was a 11-year-old girl who showed VUR into the cele ureter. The other patient was a 17-year-old female who showed VUR into the mate ureter. Satisfactory results could be obtained by twin ureteroneocystomy with cele wall resection in both cases. Complete duplex kidney is often complicated by urinary tract abnormalities such as ectopic ureterocele, VUR, and renal dysplasia, and these complications complicate its diagnosis. The treatment of complete duplex kidney with urinary tract abnormalities are discussed.

A 29 year-old male with the complaints of two steps urination and sense of residual urine was admitted. At cystoscopy, a ureterocele was found between the normal left ureteric orifice and the bladder neck. Excretory urography demonstrated a radiolucent area in the bladder and a left lower hydroureter. Retrograde pyelography revealed that the left ureter was divided into two branches. Operative exploration demonstrated that the left ureter was an inverted Y ureteral duplication with an ectopic ureterocele; one opened into the ureterocele and the other into the trigone. We resected the ureterocele wall. Four months later, a voiding cystogram did not show vesicoureteric reflux. Now, he has no symptoms and the results of examination are normal. An inverted Y ureteral duplication is the rarest of all anomalies of the ureter. A review of the literature revealed 36 cases reported previously. Clinical analysis was obtained by reviewing 26 of these cases and adding our own (male 10: female 17, average age: 23 years). Complication included 6 cases of ectopic ureteral opening, 6 with blind-ending branch and 5 with ureterocele. The symptoms of this disease depended on the complicating anomalies. The present case was the 5th one of an inverted Y ureteral duplication with a ureterocele in the world literature.

Vesicoureteral reflux (VUR) is the most common anomaly associated with duplex systems. In addition to an uncomplicated duplex system, reflux can also be secondary in the presence of an ectopic ureterocele with duplex systems. Controversy exists in regard to the initial and most definitive management of these anomalies when they coexist. This paper will highlight what is currently known about duplex systems and VUR, and will attempt to provide evidence supporting the various surgical approaches to an ectopic ureterocele and duplex system and the implications of concomitant VUR.

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartner's duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.

A case of ectopic ureterocele in a 21-year-old male is reported. His chief complaint was right flank pain. We diagnosed ectopic ureterocele in right complete ureteric duplication with upper pole and right heminephrectomy was performed. Postoperative course was uneventful and ureterocele was markedly collapsed. The 10 reported cases with adult male ectopic ureteroceles including our case in Japan are reviewed and some characteristics of this entity are discussed.

Two examples of the rare case of complete duplicated collecting system with lower pole ureteropelvic junction obstruction are described. Ureteropelvic junction obstruction (UPJO) and duplicated collecting systems seldom occur in combination. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obstruction, damage and potential for regeneration in growing kidneys. The diagnosis and management of UPJO of the lower pole in complete duplicated collecting systems are discussed.

We report a case of ectopic ureterocele in a male adult found during examination of a traumatic injury. A 26-year-old man sustained a blow to his left back during a football game and was admitted to the hospital with a complaint of abdominal pain. The computed tomographic scan showed a huge cystic mass in the retroperitoneum. A cystoscope revealed a large bulge from the left ureteral orifice to the bladder neck and another ureteral orifice distal to the bulge. Retrograde pyelography revealed an ectopic ureterocele showing a complete duplication, a lateral deviation of the left ureter and a bladder deviation to the right. An ectopic ureteral orifice was opening in the posterior urethra. An ureteral catheter inserted into this orifice revealed a dilated left ureter from the upper half of the kidney. Because the function of left upper of kidney was maintained, a transurethral incision was performed. Vesicoureteral reflux remained, but the postoperative course was uneventful. We discuss 11 cases of ectopic ureterocele in male adults including this case.

BACKGROUND AND METHODS We performed renal ultrasonographic screening on 3799 healthy 3-month-old infants, who showed up for the routine health check up in Nobeoka City, for congenital malformations of the urinary tract. RESULTS Urinary tract disorders were suspected in 139 (3.7%). Almost all ultrasonographic abnormalities of these were dissociation of CEC (Central Echo Complex). Thirty-three (24.4%) of the 135, which was 0.9% of the original 3799, were diagnosed as having significant congenital anomalies in urinary tract, such as vesicoureteral reflux (VUR) in 17, hydronephrosis in 10, unilateral renal agenesis in 2, unilateral small kidney in 2 and each case of horseshoe kidney, simple ureterocele, ectopic ureterocele, megaureter and mild dilated ureter. Minor or mild renal pelvis enlargement without the dilatation of calyx was found in 78 cases. Fifty-three of the 78 were followed more than 3 months, and complete or partial reduction of the pelvic enlargement was noted in 39 (74%), while enlarged pelvis remained unchanged in 14. There was no progressive hydronephrosis among these patients during the follow-up. Urinary tract infections were found in 6 cases (5 in VUR and 1 in ectopic ureterocele). Eleven ureters in 9 children of VUR (44%) were cured spontaneously (follow-up period: 3 months-6 months and 2 years). Surgical correction was required in 6 cases, antireflux surgery for VUR in 4, heminephroureterectomy for ectopic ureterocele in 1 and endoscopic incision of ureterocele for simple ureterocele in 1. CONCLUSION Our result indicate that infant ultrasonographic screening is a useful and valuable method of detecting urinary tract malformations.

Nous presentons une serie de 25 nouveau-nes depistes in utero, porteurs d'ureterocele ectopique dont un bilateral. Pour 18 d'entre eux soit 72% a ete pratiquee d'emblee une incision endoscopique (lE) de l'ureterocele. Dans 100 % des cas (1 bilateral) l'IE s'est averee satisfaisante en ce qui concerne la decompression de l'ureterocele. On a observe apres lE un reflux au niveau du pyelon superieur dans 44,4 % des cas. Enfin nous avons reussi a preserver le pyelon superieur pour 44,4 % des patients. 15 patients (83,3 %) traites par IE ont subi une reconstruction vesicale. Nous n'avons pas observe de cas d'incontinence. L'IE de l'ureterocele ectopique pourrait etre consideree comme le traitement de premiere intention chez le nouveau-ne. Lorsqu' elle est pratiquee precocement, cette intervention permet une decompression efficace de l'ureterocele et peut ameliorer la fonction du pole renal atteint.

Interlabial mass in infant is not common. Because of similarity of symptoms and signs of those mass and less experience of gynecologist due to those rarity, differential diagnosis is not easy. In infant, there are fi ve common interlabial masses which are prolapsed ectopic ureterocele, urethral prolapse, paraurethral cyst, hydrocolpos and rhabdomyosarcoma. Ureterocele with duplex ureter might be diagnosed, however prolapsed ureterocele through urethra is extremely rare. We found 18 months old girl with interlabial mass and diagnosed as prolapsed ectopic ureterocele by ultrasonography, magnetic resonance imaging and voiding cystourethrography. We managed by endoscopic incision of ureterocele successfully. So we report this case with a brief review of associated literatures.

A case of ectopic ureterocele in a 21-year-old male is reported. His chief complaint was right flank pain. We diagnosed ectopic ureterocele in right complete ureteric duplication with upper pole and right heminephrectomy was performed. Postoperative course was uneventful and ureterocele was markedly collapsed. The 10 reported cases with adult male ectopic ureteroceles including our case in Japan are reviewed and some characteristics of this entity are discussed.

DESCRIPTION Ureterocele is a rare cause of urinary obstruction which is commonly associated with significant renal-tract anomalies. 1 Surgical decompression soon after diagnosis and further investigations to evaluate the renal tracts are important to prevent renal complications. We present a newborn female infant with incidental large mass protruding from her vagina figure 1. The mass was firm and irreducible with no associated tenderness, vaginal discharge or bleeding. There was no antenatal or family history of concerns, and the baby was passing adequate amount of urine. The paediatrics urology and gynaecology teams evaluated the baby. Clinical assessment, abdominal ultrasound scan and examination under anaesthesia confirmed the diagnosis of prolapsed intravesical ureterocele. This was decompressed by endoscopy, and, subsequently, the baby was commenced on prophylactic antibiotics, pending exclusion of vesicoureteric reflux. Ureterocele is a cystic dilatation of the ureter, which can involve the intravesical or extravesical part of the ureter. 1 It is associated with duplex renal system in 95% of female cases and with the presence of vesicoureteric reflux, especially with the extravesical form. 12 Ureterocele has an incidence of 1/5000 to 1/12000; however, prolapsing ectopic ureterocele account for less than 5% of the total. 2 It can be asymptomatic and incidentally diagnosed during workup for urinary tract infection 1 or rarely present as urinary retention. Other differential diagnosis includes epidermal inclusion cyst, Skene's duct cyst, and hidradenoma papilliferum and mucocolpos. Clinical evaluation should include measurements of blood pressure, urine microscopy and culture. Diagnostic workup entails evaluation for associated renal duplex system and presence of vesicoureteric reflux. 3

We analyzed 17 cases of multicystic dysplastic kidney (MCDK) to document the natural history of MCDK and its management. One patient was nephrectomied for respiratory failure associated with MCDK. Follow-up studies of 14 kidneys revealed that 5 kidneys (36%) did not change in size, 7 kidneys (50%) decreased in size. Two kidneys (14%) increased in size during the follow up periods and were nephrectomized. Hypertension and malignancy was not observed in our cases. Evaluations for the contralateral kidney and urinary tract system were performed in 15 patients and 5 (33%) revealed abnormalities--two patients with VUR, 1 with PUJ stenosis, 1 with ureteral stricture and 1 with ectopic ureterocele. In our hospital, the management for MCDK is conservative in most cases. Nephrectomy is indicated when there are complications resulting from the size of MCDK, or when the kidney continues to increase in size after the second year of life.