Ureteral pseudodiverticulosis

Ureteral pseudodiverticulosis are acquired false diverticula resulting from herniation of epithelium through the muscularis layer of the ureter and characterized by the presence of multiple outpouchings smaller than 5 mm. It is sometimes bilateral and is often located in the upper two-thirds of the ureter.

Epidemiology

The prevalence is relatively uncommon. It is most often seen in men between 40-60 years old.

Clinical presentation

Most patients are asymptomatic, but it may be seen in patients with a history of chronic urinary tract infection or hematuria.

Pathology

The etiology and clinical significance of ureteral pseudodiverticulosis are not clear, but chronic inflammation and/or obstruction are likely causes.

Histologically, they demonstrate focal hyperplasia of the urothelium protruding into the muscularis.

An association between the presence of ureteral pseudodiverticula and transitional cell carcinoma has been shown, but a causal relationship has not been demonstrated.

Radiographic features

Multiple small outpouchings along bilateral walls of the proximal two-thirds of the ureter. These are most often seen on intravenous urography, antegrade urography, or retrograde pyelography. Very infrequently, pseudodiverticulosis may be detected on multidetector CT.

Treatment and prognosis

There is no specific treatment indicated in asymptomatic patients. In the past, since there was an association between pseudodiverticulosis and urothelial carcinoma, more aggressive surveillance had been performed, but it is unclear if this is surveillance is useful ⁴.

Differential diagnosis

• ureteritis cystica

• true ureteral diverticula