9.3.1 Ureterocele

Prenatal ultrasound reveals easily voluminous obstructive ureteroceles. In cases of a very small upper pole or a slightly obstructive ureterocele, prenatal diagnosis will be difficult. If prenatal diagnosis has been impossible, the following clinical symptoms - beside incidental findings - can reveal the congenital anomaly at birth or later:

1. At birth, a prolapsed and sometimes strangulated ureterocele may be observed in front of the urethral orifice. In a neonate boy, it might cause acute urinary retention, simulating urethral valves.

2. The early symptom of pyelonephritis in either sex may lead to the diagnosis.

3. Later symptoms can include dysuria, recurrent cystitis and urgency.

In cases of prenatal diagnosis at birth, ultrasonography confirms the ureteral dilatation ending at the upper pole of a renal duplication. It also demonstrates the presence of an ureterocele in the bladder, with a dilated ureter behind the bladder.

At this point it is important to assess the function of the upper pole using excretory urography and/or nuclear renography in the region of interest. Urography might visualize the morphological status of the upper pole and lower moieties and of the contralateral kidney. A VCUG is mandatory in identifying an ipsilateral or contralateral reflux and to assess the degree of intraurethral prolapse of the ureterocele.

When the differential diagnosis between ureterocele and ectopic megaureter is difficult, urethrocystoscopy might reveal the pathology.