Introduction:
The ureterocele is an opening in the area where the ureter enters the bladder. It is a rare birth defect which means it is present at birth. It is not clear why the ureteroceles formed, but it is thought to be due to the abnormal formation of the ureter tube as it is inserted into the bladder. The ureteroceles occur in about one in 1000 babies and are most common in the double kidney, a kidney with two ureters that protrude from the bladder. When the ureterocele is associated with duplex kidneys, it is the ureter that drains the upper part of the kidney with the ureterocele. As a result, kidneys with ureterocele are often enlarged and may have impaired urinary flow.
What Is a Ureterocele?
They are birth defects that occur during pregnancy. The ends of the ureter entering the bladder do not grow well. Ureterocele inhibits urine flow. These can be detected before birth. Treatment depends on when it is diagnosed.
What Are the Causes of Ureterocele?
A birth defect formed in the prenatal period (in the womb) itself is not preventable but can be treated.
What Are the Different Types of Ureteroceles?
The ureteroceles may be classified based on their relationship with the kidney unit or in the distal ureteral location. The following are the different types of ureteroceles that are classified by their association with the kidney unit:
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The ureteroceles of the single system are those associated with a single kidney, collection system, and ureter.
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Duplex-system ureteroceles are associated with kidneys with fully recurrent ureters.
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Orthotopic (intravesical) is contained in the bladder. The orthotopic ureterocele may continue to penetrate beyond the neck of the bladder, but the origin of the orthotopic ureterocele walls is included in the bladder. Orthotopic ureterocele usually occurs in one part of the kidney with a single collection system and is most commonly found in adults.
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Ectopic (extravesical) ureterocele refers to ureteroceles that have tissue from the neck of the bladder or beyond into the urine. And are very common in children.
What Are the Symptoms of Ureterocele?
Most people with ureteroceles have no symptoms. When symptoms appear, they may be due to an infection of the urinary tract. The symptoms include:
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Back pain can only be on one side.
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Severe pain in the side (flank) and spasms may reach the groin, genitals, and thigh.
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Blood in the urine.
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Pain while urinating.
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Difficulty in initiating urine flow or reducing urine flow.
How Is an Uterocele Diagnosed?
Most babies with ureteroceles are diagnosed during the fetal examination before birth. Still, they may not be diagnosed until the patient is diagnosed with another condition, such as a urinary tract infection.
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Ultrasonography: It is used to allow radiologists to examine the ureterocele.
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Voiding Cystourethrogram (VCUG): It is usually performed to determine the type of ureterocele, the effect on the bladder's function, and if there is any flexibility in any ureter. The catheter is inserted through the baby's urethra into the bladder. The tube will be used to fill the bladder with the solution slowly. While the bladder is being loaded, special fluoroscopy is used to take pictures. As the bladder fills, the ureterocele can be seen.
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Kidney Scan(DMSA or MAG-3): It is usually performed to check kidney function.
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MAG-III Renal Scan: It isperformed to determine how each kidney works and the degree of blockage. An artery (IV) line is injected into the arteries. Isotope makes it possible to see the kidneys clearly. Kidney pictures will be taken.
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Abdominal Computed Tomography (CT) Scans and Magnetic Resonance Imaging (MRI) Scans: These are additional studies that can be performed in cases where the anatomy of the urinary tract is less clear and will allow the surgeon to visualize anatomical differences better.
How Is an Uterocele Treated?
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If ureterocele is acquired before birth, low doses of prophylactic antibiotics are often recommended depending on the severity. A minor procedure called ureterocele puncture is usually performed in the first few weeks of life. This procedure involves transferring a small camera to the bladder although the urethra and piercing the ureterocele into the bladder to relieve any discomfort. Ureterocele piercing is done as soon as the baby is found to have an infection.
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In older children, the ureteroceles are sometimes treated differently depending on how well the kidneys function, how large the ureterocele is, how badly the ureter and kidney stretch, how the kidneys are duplex, and whether the other ureter is duplex. The kidneys have reflux. Treatment options range from attention to several types of urinary tract rehabilitation surgery.
Some of the Treatment Procedures Are:
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Transurethral Puncture: A minimally invasive treatment that pierces and compresses the ureterocele using a cystoscope inserted through a tube.
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Upper Pole Nephrectomy: If the upper part of the kidney (the part associated with the ureterocele) is inactive due to the ureterocele and there is no vesicoureteral reflux, it is recommended to remove the affected part of the kidney. This can be done with open surgery, laparoscopic surgery, or robotic surgery.
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Nephrectomy: If the entire kidney is not functioning due to a ureterocele, kidney removal is recommended. This can be done with open surgery, laparoscopic surgery, or robot surgery.
What Are the Possible Complications of Ureterocele?
The possible complications include :
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Long-term bladder damage (urinary retention).
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Long-term kidney damage, including loss of function in one kidney.
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Recurrent UTI (urinary tract infection that keeps coming back).
Conclusion :
There is no need to panic if your child is diagnosed with ureterocele. It can be treated, and the child can lead a normal life after treatment, and if the problem is diagnosed in adulthood, it can be treated. In some cases, in order to prevent urinary tract infections, antibiotics are given, which have to be taken regularly. With the help of early diagnosis and proper treatment, one can prevent complications due to ureterocele to an extent.
