Ureterocele

Dr Tee Yu Jin and A.Prof Frank Gaillard et al.

Ureteroceles represent 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).

Most ureteroceles 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). 

Most cases have a sporadic occurrence.

Ureteroceles are classified by location. The most common system of classification is that of the urologic division of American Academy of Pediatrics 6,7. Both types are the result of cystic ectasia of the subepithelial portion of the ureter as it enters the bladder:

  • intravesical: occur at the normal VUJ position
  • extravesical: occur ectopically low and medial, near bladder neck/urethra

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

Also known as "simple" or "orthotopic" ureterocele 4,6. Considerably less common than 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 occur in children, they usually cause symptoms. Bilateral in about 30% of cases 2.

Also known as "ectopic" ureterocele 4,6. Almost always associated with a duplicated collecting system and the result of abnormal embryogenesis. There is an 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, ureteroceles may contain calculi.

A cecoureterocele is a subtype of extravesical ureterocele which extends inferiorly to involve the urethra. Rarely, it may herniate into the urethra and present as a perineal mass 4,8.

A ureterocele appears as a cystic structure projecting into the bladder, often near the normal location of the vesicoureteric junction (VUJ). This is ectopic in the majority of cases and therefore not at the expected location of the ureteric orifice. The associated ureter is usually noticeably dilated. 

Detectable findings include:

Voiding cystourethrogram may show:

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

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

General imaging differential considerations include:

  • pseudoureterocele2
    • obstruction and dilatation of an otherwise normal intramural ureter
    • thick, irregular halo in urinary bladder
    • no protrusion of ureter into bladder lumen
  • bladder diverticulum 
    • the ureterocele is everted
Anatomy: Abdominopelvic
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Article information

rID: 2244
Synonyms or Alternate Spellings:
  • Ureterocoele
  • Ureteroceles
  • Ureterocoeles
  • Cecoureterocele

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Cases and figures

  • Case 1: ureterocele in an infant
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  • Case 2: ureterocele with dilated upper pole ureter
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  • Case 3: ureterocele with duplex left kidney
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  • 1
    Case 4: antenatal ureterocele
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  • Ureterocoele
    Case 5: bilateral ureteroceles
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  • Case 6
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  • Case 6: with duplex collecting system
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  • Case 7: simple with calculi
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  • Case 8
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  • Case 9: duplex collecting system
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  •  Case 10
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  • Ureterocele
    Case 11: bilateral simple orthoptic ureteroceles
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  • Case 12: calculus in ureterocele
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  • Case 13
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  • Case 14
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  • Case 15
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  • Case 16
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  • Case 16: cobra head sign
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