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Ectopic ureterocele without ureteral and calyceal dilatation (ureterocele disproportion): findings on urography and
1Department of Radiology, Children's Hospital, Boston, MA 02115.
Insights
Ureterocele disproportion is a rare condition in children involving duplex collecting systems and ectopic ureteroceles, characterized by significant size differences. Early diagnosis via imaging and prompt surgical intervention are crucial for managing associated urinary infections and reflux.
Area of Science:
- Pediatric Urology
- Radiology
- Surgical Innovation
Background:
- Duplex collecting systems and ectopic ureteroceles can present with complex anatomical variations.
- Subtle or absent signs of duplication complicate diagnosis in some pediatric cases.
Purpose of the Study:
- To describe a distinct clinical entity termed 'ureterocele disproportion' in infants and children.
- To highlight diagnostic challenges and management strategies for this condition.
Main Methods:
- Retrospective review of eight pediatric patients over 13 years with duplex collecting systems and ectopic ureteroceles.
- Diagnostic modalities included urography, sonography, and cystoscopy with ureterocele puncture.
- Surgical interventions were tailored to individual patient findings.
Main Results:
- Seven patients presented with urinary infection; one had in utero hydronephrosis.
- Five patients exhibited significant ipsilateral lower-pole reflux (grade 3-5).
- Ureterocele disproportion was diagnosed via imaging and confirmed cystoscopically.
Conclusions:
- Ureterocele disproportion is a recognizable entity characterized by size discrepancy between the ureterocele and its associated ureter/calyces.
- Prompt diagnosis and appropriate surgical management are essential for favorable outcomes in affected children.
Abstract:
Eight infants and children (six girls) were seen over a 13-year period with duplex collecting systems and ectopic ureteroceles. In each, there was striking dissimilarity in size between the large ureterocele and its diminutive ureter and calyces. The upper moiety did not function and, except for the ureterocele, the indirect urographic and direct sonographic signs of duplication were absent or subtle. We call this entity ureterocele disproportion. Seven patients presented with urinary infection and one was found to have hydronephrosis of a dilated lower moiety in utero. Five had ipsilateral lower-pole reflux, which ranged in degree from 3 to 5 (on a scale of 1-5). Two had bilateral duplication; one of these had a typical contralateral ectopic ureterocele. The diagnosis of ureterocele disproportion was strongly suggested by urography and sonography and was confirmed at cystoscopy by direct puncture of the ureterocele and opacification of the upper moiety. All had surgery. The approach varied and depended on the status of the lower moiety and the contralateral kidney. One had incision of the ureterocele only. Five with lower-pole reflux had excision of the ureterocele and ipsilateral common-sheath reimplantation.