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Ureterocoele

Dr Yuranga Weerakkody and Dr Frank Gaillard et al.

A ureterocoele is a congenital dilatation of the distal-most portion of the ureter. The dilated portion of the ureter may herniate into the bladder secondary to the abnormal structure of vesicoureteric junction (VUJ).

Epidemiology

Most ureterocoeles are congenital, usually associated with ectopic insertion of the ureter with associated duplicated collecting system (see below).

In a minority of cases, ureteroceles are an isolated abnormality, and these are usually seen in adults (see below).

Pathology

Genetics

Most cases have a sporadic occurrence.

Location and classification

There are two main types of ureterocoele, both of which are the result of cystic ectasia of the subepithelial portion of the ureter as it inters the bladder.

simple - a ureterocoele that occurs at a VUJ in a normal position
ectopic - that which occurs at a VUJ whose site is abnormal

They pose a challenge for diagnosis and treatment because of the wide variety of anatomical abnormalties that may exist and the non-specific symptoms that patients present with.

Simple ureterocoele: ~ 25 %

Considerably less common that the ectopic variety and is almost always confined to the adult population. There is a congenital prolapse of a dilated distal ureter into the bladder lumen. Where they do do occur in children, they usually cause symptoms. Bilateral in about 30% of cases ².

Ectopic ureterocoele: ~ 75 %

Almost always associated with a duplicated collecting system and the result of abnormal embryogenesis. There is abnormality in the early development of the intravesicular ureter, the ipsilateral kidney and its collecting system ¹. It is significantly more common than the simple type.

Approximately 80% of cases are unilateral and may cause obstruction to the entire renal tract because of prolapse into the bladder neck causing bladder outlet obstruction. Additionally, ureterocoeles may contain calculi.

Radiographic features

Ultrasound

A ureterocoele appear as a cystic structure projecting into the bladder, often near the normal location of the vesicoureteric junction (VUJ) - note that insertion can be ectopic. The associated ureter is usually noticeably dilated.

Fluoroscopy

IVP

Detectable findings include

filling defect in the bladder (cobra head sign) which may be distended, collapsed or even everted
radiolucent halo effect
an everted ureterocoele will appear like a bladder diverticulum

MCUG

may show a round or oval lucency near the trigone
there may be effacement of the defect with increasing filling of the bladder

Complications

progression to obstructive cystic renal dysplasia

Treatment and prognosis

The prognosis of ureterocoeles are related to the degree of associated reflux or obstruction. Depending on the size and position of a ureterocoele, they may prolapse into the ureter causing complete bladder obstruction.