Ureterocele

Ureterocele is a congenital condition – present at birth – where the end of the ureter, the tube that transports urine from the kidneys to the bladder, bulges and forms a cyst in the bladder. This can obstruct urine flow and even affect kidney function. It is often detected during prenatal ultrasounds (during pregnancy) or in early childhood. While more common in females (by 10x), ureteroceles tend to be more complex in males. They occur in approximately 1 in 2000 births and are more common in Caucasian children.

Why Is It So Common in Females?

Female children are far more at risk of a condition known as a duplex collecting system. This occurs when the kidney has two ureters instead of the usual one. Most kids with a ureterocele also have a duplex collecting system.

Symptoms

Diagnosis

During pregnancy, ureteroceles, if present, are often noticed in the baby during a prenatal ultrasound. Once born, postnatal imaging studies such as ultrasounds, voiding cystourethrograms (x-ray imaging of the bladder), and Magnetic Resonance Urography (MRI of the urinary tract) help detect ureteroceles.

Treatment

Treatment options vary from conservative to surgical depending on the child’s symptoms, medical history, and the severity of the ureterocele. For example, a small mild ureterocele that is not causing a blockage or backup of urine is often observed and checked for progression with ultrasound. A very large ureterocele that causes urinary tract infections, bladder outlet obstruction, vesicoureteral reflux, or other urinary tract issues may need to be corrected more urgently and likely surgically. Most importantly, treatment should be started early due to the possible risk of kidney damage if left untreated.

Conservative Management

  • Monitoring asymptomatic children
  • Prescribing antibiotics prophylactically to prevent infections from worsening
  • Follow ureterocele size and kidney growth with ultrasound

Surgical Intervention

  • Endoscopic puncture or incision of the ureterocele. Endoscopies of the bladder are called cystoscopies and use the body’s natural urinary system rather than incisions.
  • Ureteral reimplantation and ureterocele excision in severe cases. In this procedure, the ureter is removed and reattached.
  • Rarely, an upper pole heminephrectomy (partial kidney removal) may be required.

Follow Up

Children with ureterocele require regular follow-ups to monitor kidney function and prevent complications such as recurrent infections and renal damage. Even the most severe cases have an excellent outlook as long as they are treated appropriately and early. Complications often arise when treatment is delayed, or the condition is not found early. Contact your trusted pediatric urologist to learn more about ureterocele treatment. Depending on how it is found, your OB/GYN, pediatric team, and pediatric urologist will work together to develop an appropriate treatment plan.