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Ureterocele

Ureteroceles are cystic dilations of the very end of the ureter, or the part of the ureter that enters the bladder.  They can be detected on pre-natal ultrasounds if they are large or causing some degree of obstruction to the urinary system.  The ballooning at the end of the ureter can be seen on ultrasound.  A child may also present with a urinary tract infection or a kidney infection.  In this setting, the child can get very sick if not treated immediately.

In many cases, newborns are started on antibiotic prophylaxis and evaluated with an ultrasound and often a voiding cystourethrogram (VCUG).  Further imaging may be done such as an MRI or a nuclear medicine renal scan.  Ureteroceles can vary in location, size, and whether the opening is tight or wide.  Some children only need to be observed, but in some cases the ureterocele will need to be punctured using a very small telescope passed through the urethra in the operating room.  They are followed closely after as many will develop vesicoureteral reflux (VUR) after this procedure.  A second surgery including excision of the ureterocele and reimplantation of the ureter is often done at a later stage as long as the child is doing well.

When ureteroceles are associated with duplicated ureters, other surgical options such as connecting two ureters together, removing non-functional parts of kidneys, and reimplanting both ureters on that side may be discussed.