An Overview of Ureterocele

Ureteroceles are a congenital abnormality that causes a ureter to swell, which prevents the normal flow of urine from the kidneys to the bladder.

Each kidney has a single ureter that allows urine to pass into the bladder. Ureteroceles are a swelling or "ballooning" that occurs at the end of one or both of the ureters, which obstructs the flow of urine.

Ureteroceles happen during embryonic development, which means a person is born with one. Most are diagnosed at birth and typically a person who has a ureterocele doesn't experience symptoms. It's possible that a person who was born with a ureterocele may be more prone to getting urinary tract infections (UTI) or kidney infections.

If a person gets UTIs or kidney infections frequently, even starting in childhood, or if they have urinary symptoms that seem to keep coming back (or never go away) they may have been born with a ureterocele. These symptoms could include:

• Pain or burning when urinating (dysuria)
• Urine that smells bad
• Having to urinate frequently/being woken up at night to urinate
• Blood in urine (hematuria)
• Abdominal, flank, and back pain (which may be cyclic)
• Abdominal tenderness
• Trouble urinating or being completely unable to
• Fever and chills
• Failure to thrive in newborns
• Older children and adults may be more prone to kidney stones

Typically, a person will only have a ureterocele on one side (unilateral) but they can occur in both ureters (bilateral). Some research indicates the abnormality happens more often on the left side.

Ureteroceles form during embryonic development. The condition is present at birth and is usually diagnosed shortly after a baby is born. In fact, the condition is sometimes even diagnosed while a fetus is still in utero, as "ballooning" of the ureter can be seen on ultrasound during prenatal exams.

Ninety percent of people who are born with ureteroceles are also found to have two ureters in a single kidney; a condition known as duplex kidney. When a person has both a duplex kidney and a ureterocele, it's sometimes referred to as a "duplex collecting system."

Most ureteroceles are diagnosed in infancy and at the latest by the age of 2. When the condition is diagnosed in an older child or adult, it's often discovered during a routine test or scan that's looking for something else. Children or adults who have frequent urinary tract or kidney infections may also ultimately be diagnosed with a ureterocele.

When a ureterocele causes the flow of urine from the kidney to the bladder to become obstructed, the blockage causes the kidney to swell (hydronephrosis). The obstruction and swelling can also cause a backflow of urine into the kidneys; a condition called vesicoureteral reflux (VUR). The blockage and swelling can usually be seen on an ultrasound, making the imaging technology a reliable way to diagnose the condition.

When a person is told they have a ureterocele they may be told its classification. Ureteroceles are classified by whether:

• they are on one or both sides
• they are part of a single or duplex system
• the swelling is mild or severe
• they are inside (intravesical or orthotopic) or outside (extravesical or ectopic) the bladder

While most ureteroceles can be diagnosed with an ultrasound a doctor might order several other kinds of tests as well. A series of X-rays of the bladder (voiding cystourethrogram) can help a doctor see how well a person's bladder is emptying. A nuclear renal scan will show a doctor if a person's kidneys have been damaged. If surgery is needed, an MRI or CT scan can help evaluate the urinary tract before a patient has a procedure.

If a person goes to the doctor with symptoms of a UTI or kidney infection, a doctor usually orders lab tests to examine a sample of their urine (urinalysis) and blood to confirm an infection. If these infections are severe or go untreated, they can lead to a serious blood infection. While it isn't common, the potentially life-threatening complication, called sepsis, can happen to infants, children, or adults.

If a ureterocele is diagnosed during a prenatal exam, antibiotics may be started before birth to help reduce the risk of infection. When a newborn is found to have a ureterocele, a simple puncture procedure can often be performed shortly after birth that resolves the "ballooning" of the ureter by "popping" it.

For children and adults who are found to have ureteroceles, the puncture procedure may be performed in an emergency situation, such as if the person has developed sepsis. Otherwise, the treatment a doctor recommends will usually depend on how severe the condition is and whether or not the person is having any symptoms.

If a ureterocele is mild and not causing a person symptoms, their doctor might suggest a "watch and wait" approach. If a person's kidney function is affected, the kidney has been damaged, a person is experiencing urinary symptoms, getting recurrent UTIs, or having intractable pain, the options for treatment range from taking a small dose of antibiotics daily to having reconstructive surgery.

Whether managed conservatively or surgically, most ureteroceles do not cause long-term problems. With proper diagnosis, treatment, and monitoring, a person who was born with a ureterocele can live a healthy life and rarely experiences any longterm problems with their urinary system.

Ureteroceles are a highly treatable congenital abnormality that causes a ureter to swell and prevent the normal flow of urine from the kidneys to the bladder. Most ureteroceles are diagnosed in infancy, sometimes even prenatally, and are more common in females. Depending on the severity of the birth defect and whether or not a person is having symptoms, treatment ranges from the conservative "watch and wait" approach to reconstructive surgery. Children born with a ureterocele rarely experience have any longterm health problems associated with the condition.