An Overview of Ureterocele

Each kidney has a single ureter that allows urine to pass into the bladder. Ureteroceles are a congenital abnormality that causes a ureter to swell. This ballooning at the end of one or both ureters prevents normal urine flow between the kidneys and bladder.

This article explains the symptoms, diagnosis, and treatment of ureteroceles.

Symptoms

Ureteroceles happen during embryonic development. That means if you have one, you were born with it. Most of the time, doctors diagnose ureteroceles at birth. Typically a person who has a ureterocele doesn't experience symptoms.

It's possible that if you were born with a ureterocele, you might be more prone to getting urinary tract infections (UTIs) or kidney infections.

If you get UTIs or kidney infections frequently, even starting in childhood, or if you have urinary symptoms that seem to keep coming back (or never go away), you 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 (nocturia)
• Blood in the urine (hematuria)
• Abdominal, flank, and back pain (which may be cyclic)
• Abdominal tenderness
• Trouble urinating or being completely unable to urinate (urinary retention)
• Fever and chills
• Failure to thrive in newborns
• Kidney stones (in older children and adults)

Typically, people 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.

Diagnosis

Ureteroceles form during embryonic development. So, the condition is present at birth, and doctors usually diagnose it shortly after a baby is born.

In fact, "ballooning" of the ureter can be seen on ultrasound during prenatal exams. So, the condition is sometimes even diagnosed while a fetus is still in utero.

While most ureteroceles can be diagnosed with an ultrasound, a doctor might also order several other kinds of tests. These may include:

• X-ray: A series of X-rays of the bladder (voiding cystourethrogram) can help a doctor see how well your bladder is emptying.
• Nuclear renal scan: This test will show a doctor if your kidneys have been damaged.
• MRI or CT scan: If you need surgery, a magnetic resonance imaging (MRI) or computed tomography (CT scan) can help evaluate the urinary tract before you have a procedure.

Most ureteroceles are diagnosed in infancy and at the latest by the age of 2. When the doctors diagnose the condition in an older child or adult, they often discover it 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.

Multiple Diagnoses

Sometimes, when a doctor discovers a ureterocele, they will also find other conditions. Or ureteroceles may lead to other problems. Some examples include:

• Duplex kidney: Ninety percent of people born with ureteroceles are also found to have two ureters in a single kidney, a condition known as duplex kidney.
• Duplex collecting system: When a person has both a duplex kidney and a ureterocele, it's sometimes referred to as a "duplex collecting system."
• Hydronephrosis: When a ureterocele causes the urine flow from the kidney to the bladder to become obstructed, the blockage causes the kidney to swell.
• Vesicoureteral reflux: The obstruction and swelling can also cause a backflow of urine into the kidneys. The blockage and swelling can usually be seen on an ultrasound, making the imaging technology a reliable way to diagnose the condition.

Classification

When your doctor tells you that you have a ureterocele, they may also tell you 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
  

Treatment

If your doctor diagnoses a ureterocele during a prenatal exam, doctors may start antibiotics before birth to help reduce the risk of infection. Other treatments include surgery and watchful waiting.

Surgery

The goal of surgery is to eliminate the blockage. When a newborn has a ureterocele, a simple puncture procedure can often be performed shortly after birth. This procedure can resolve the "ballooning" of the ureter by "popping" it.

For children and adults with ureteroceles, a doctor may perform the puncture procedure in an emergency, such as if you develop sepsis. Otherwise, the treatment a doctor recommends will usually depend on how severe the condition is and whether or not the person has any symptoms.

Watchful Waiting

If a ureterocele is mild and not causing symptoms, your doctor might suggest a "watch and wait" approach. Certain things, however, may require further intervention, like antibiotics or surgery. Further treatment may be recommended if:

• Your kidney function is affected
• Your kidney has been damaged
• You are experiencing urinary symptoms
• You are getting recurrent UTIs
• You have unmanageable pain

Summary

Ureteroceles are a congenital condition where the end of a ureter swells, preventing urine flow from the kidney to the bladder. Whether managed conservatively or surgically, most ureteroceles do not cause long-term problems.

A Word From Verywell

If you have been diagnosed with a ureterocele, you may be worried. Rest assured that most of the time, people with ureteroceles rarely experience any long-term problems.

With proper diagnosis, treatment, and monitoring, you can live a healthy life with a ureterocele. If you notice any signs of infection, like a burning sensation while urinating, a constant need to urinate, foul odor, cloudy urine, pelvic pain, or fever, seek medical attention right away.