What is it
The ureter drains into the bladder through a narrow opening. If during intrauterine development the orifice is formed too narrow, and the wall of the ureter in this place remains weak, its final section, under the pressure of urine, swells and protrudes into the cavity of the bladder.
The result is a thin-walled bladder that fills when urine enters and is not completely emptied. Inside it, urine stagnates, which contributes to infections and the formation of stones, and dilatation and hydronephrosis develop higher up the ureter.
- Intravesical ureterocele - located entirely inside the bladder; more often associated with a single ureter and is milder
- Ectopic ureterocele - partially extends into the neck of the bladder or into the urethra; almost always associated with kidney duplication and is more severe
Symptoms
- Often there are no symptoms - an ultrasound finding
- Recurrent urinary tract infections and pyelonephritis
- Episodes of high fever without catarrhal symptoms in children
- Pain in the lower back and lower abdomen
- Difficulty urinating, weak stream
- Interruption of urine stream
- Acute urinary retention with large ectopic ureterocele
- Incontinence or urine leakage
- Blood in urine
- In girls, prolapse of the formation from the external opening of the urethra
- Stones inside ureterocele
Why is it dangerous?
- Impaired urine outflow with the development of hydronephrosis and hydroureter
- Recurrent pyelonephritis
- Gradual loss of function of the corresponding segment of the kidney
- Vesicoureteral reflux, including into the adjacent ureter
- Stones inside the ureterocele cavity
- Bladder neck obstruction with urinary retention
- Chronic kidney disease with bilateral damage
Diagnostics
- Ultrasound of the bladder during filling - a characteristic round formation in the projection of the orifice of the ureter
- Ultrasound of the kidneys - assessment of the expansion of the pelvis and ureter, the thickness of the parenchyma
- Victory cystourethrography - detection of reflux and assessment of the position of ureterocele
- CT or MR urography - anatomy of kidney duplication
- Cystoscopy - direct visualization; can simultaneously become a therapeutic procedure
- Dynamic nephroscintigraphy - assessment of the function of the kidney segment, key to choosing tactics
- General analysis and urine culture
- Blood creatinine
An important nuance of ultrasound: if the bladder is full, the ureterocele may be compressed and not visualized, but if the bladder is empty, it may be invisible. Therefore, the study is performed with moderate filling and repeated if necessary.
Treatment
- Observation - with a small asymptomatic ureterocele without obstruction of urine outflow and without infections
- Endoscopic dissection of ureterocele - puncture or incision of the wall through a cystoscope; low-traumatic first-line method, quickly restores outflow
- Antibacterial prophylaxis of infections before and after intervention
- Ureterocystoneoanastomosis with excision of ureterocele - for reflux after dissection or in case of complex anatomy
- Heminephroureterectomy - removal of the non-functioning upper segment during kidney duplication
- Ureteral stenting for acute outflow obstruction
- Removing stones from the ureterocele cavity
Observation after treatment
- Control ultrasound of the kidneys and bladder at the appointed time
- Periodic urine tests, especially during episodes of fever
- Void cystography to detect reflux after dissection
- Nephroscintigraphy to assess kidney function over time
- Blood pressure control
- Observation by a urologist for several years
Where is ureterocele treated in Tashkent
Ultrasound diagnostics, a cystoscopic stand for endoscopic dissection and the ability to perform reconstructive surgery for complex forms are required.
In Tashkent, examination and treatment of ureterocele is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If a ureterocele is detected in a child after an episode of pyelonephritis, continue the examination to assess kidney function: it is this that determines whether dissection is sufficient or whether a more extensive operation is needed. Clinic contacts are below.
