Ureterocoele

Ureterocoeles 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 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). 

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 enters 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 abnormalities that may exist and the non-specific symptoms that patients present with.

Simple ureterocoele (~25%)

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.

Ectopic ureterocoele (~75%)

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, ureterocoeles may contain calculi. 

Ultrasound

A ureterocoele 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. 

Fluoroscopy
IVP

Detectable findings include:

MCUG

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 ureterocoele, they may prolapse into the ureter causing complete bladder obstruction.

General imaging differential considerations include:

Abdominal and pelvic anatomy
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Article Information

rID: 2244
Section: Anatomy
Synonyms or Alternate Spellings:
  • Ureterocele
  • Ureteroceles
  • Ureterocoeles

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Cases and Figures

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    Case 1: ureterocoele in an infant
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    Case 2: ureterocele with dilated upper pole ureter
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    Duplex left kidney
    Case 3: ureterocoele with duplex left kidney
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    1
    Case 4: antenatal ureterocoele
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    Ureterocoele
    Case 5: bilateral ureterocoeles
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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 ureterocoeles
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    Calculus in urete...
    Case 12: calculus in ureterocoele
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    Case 13
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    Case 14
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    Case 15
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