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Genitourinary
Diagnosis
Ureter
Congenital
Ureterocele
Ureterocele
Bryan R. Foster, MD; Amir A. Borhani, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Definitions

              • Cystic dilatation of terminal ureter
              • Several classification schemes exist; most commonly used [introduced by American Academy of Pediatrics (AAP)] divides ureteroceles into intravesical and ectopic
                • Intravesical: Ureterocele is entirely in bladder
                • Ectopic: Insertion other than orthotopic position
                  • Typically in bladder neck or urethra
                  • More common with duplicated systems
                • Older classification (introduced in 1954) divided ureteroceles into simple (orthotopic) and ectopic; however, this classification has been largely abandoned due to confusion with word "simple"
                  • "Simple" ureterocele can be seen with both simple and duplex collecting systems
              • ~ 80% of ureteroceles (in pediatric population) are seen in association with duplicated collecting system
                • ~ 60% of these have ectopic insertion

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            Selected References

                                            1. Srisajjakul S et al: Diagnostic clues, pitfalls, and imaging characteristics of '-celes' that arise in abdominal and pelvic structures. Abdom Radiol (NY). 45(11):3638-52, 2020
                                            2. Hirshberg B et al: MDCT imaging of acute bladder pathology. Curr Probl Diagn Radiol. 49(6):422-30, 2020
                                            3. Czarniecki M et al: Case 267: cecureterocoele manifesting in a man with infertility. Radiology. 292(1):263-6, 2019
                                            4. Atta ON et al: An adult ureterocele complicated by a large stone: a case report. Int J Surg Case Rep. 44:166-71, 2018
                                            5. Rompré-Brodeur A et al: Adult bilateral ureteroceles presenting with lower urinary tract symptoms and acute urinary retention. Case Rep Urol. 2018:3186060, 2018
                                            6. Xiang H et al: Cobra head sign: ureterocele. J Med Imaging Radiat Oncol. 62 Suppl 1:67, 2018
                                            7. Didier RA et al: The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 47(11):1526-38, 2017
                                            8. Cohen SA et al: Examining trends in the treatment of ureterocele yields no definitive solution. J Pediatr Urol. 11(1):29.e1-6, 2015
                                            9. Adeb M et al: Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 21(4):717-30, 2013
                                            10. Debenedectis CM et al: Incidental genitourinary findings on obstetrics/gynecology ultrasound. Ultrasound Q. 28(4):293-8, 2012
                                            11. Jesus LE et al: Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles. J Urol. 186(4):1455-8, 2011
                                            12. Pohl HG: Recent advances in the management of ureteroceles in infants and children: why less may be more. Curr Opin Urol. 21(4):322-7, 2011
                                            13. Lewis JM et al: Complete excision or marsupialization of ureteroceles: does choice of surgical approach affect outcome?. J Urol. 180(4 Suppl):1819-22; discussion 1822-3, 2008
                                            14. Singh I: Adult bilateral non-obstructing orthotopic ureteroceles with multiple calculi: endoscopic management with review of literature. Int Urol Nephrol. 39(1):71-4, 2007
                                            15. Byun E et al: A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. J Urol. 176(4 Pt 2):1871-7; discussion 1877, 2006
                                            16. Merlini E et al: Obstructive ureterocele-an ongoing challenge. World J Urol. 22(2):107-14, 2004
                                            17. Berrocal T et al: Anomalies of the distal ureter, bladder, and urethra in children: Embryologic, radiologic, and pathologic features. RadioGraphics 22: 1139-1164; 2002
                                            18. Shokeir AA et al: Ureterocele: an ongoing challenge in infancy and childhood. BJU Int. 90(8):777-83, 2002
                                            19. Walsh PC et al: Campbell's Urology. 8th ed. Saunders. 2007-52, 2002
                                            20. Chertin B et al: Endoscopic puncture of ureterocele as a minimally invasive and effective long-term procedure in children. Eur Urol. 39(3):332-6, 2001
                                            21. Davidson AJ et al: Radiology of the kidney and genitourinary tract. 3rd ed. Saunders. 213-6, 1999
                                            22. Bellah RD et al: Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography. AJR Am J Roentgenol. 165(2):409-13, 1995
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Definitions

                                                        • Cystic dilatation of terminal ureter
                                                        • Several classification schemes exist; most commonly used [introduced by American Academy of Pediatrics (AAP)] divides ureteroceles into intravesical and ectopic
                                                          • Intravesical: Ureterocele is entirely in bladder
                                                          • Ectopic: Insertion other than orthotopic position
                                                            • Typically in bladder neck or urethra
                                                            • More common with duplicated systems
                                                          • Older classification (introduced in 1954) divided ureteroceles into simple (orthotopic) and ectopic; however, this classification has been largely abandoned due to confusion with word "simple"
                                                            • "Simple" ureterocele can be seen with both simple and duplex collecting systems
                                                        • ~ 80% of ureteroceles (in pediatric population) are seen in association with duplicated collecting system
                                                          • ~ 60% of these have ectopic insertion

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Ultrasonographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      Selected References

                                                                                      1. Srisajjakul S et al: Diagnostic clues, pitfalls, and imaging characteristics of '-celes' that arise in abdominal and pelvic structures. Abdom Radiol (NY). 45(11):3638-52, 2020
                                                                                      2. Hirshberg B et al: MDCT imaging of acute bladder pathology. Curr Probl Diagn Radiol. 49(6):422-30, 2020
                                                                                      3. Czarniecki M et al: Case 267: cecureterocoele manifesting in a man with infertility. Radiology. 292(1):263-6, 2019
                                                                                      4. Atta ON et al: An adult ureterocele complicated by a large stone: a case report. Int J Surg Case Rep. 44:166-71, 2018
                                                                                      5. Rompré-Brodeur A et al: Adult bilateral ureteroceles presenting with lower urinary tract symptoms and acute urinary retention. Case Rep Urol. 2018:3186060, 2018
                                                                                      6. Xiang H et al: Cobra head sign: ureterocele. J Med Imaging Radiat Oncol. 62 Suppl 1:67, 2018
                                                                                      7. Didier RA et al: The duplicated collecting system of the urinary tract: embryology, imaging appearances and clinical considerations. Pediatr Radiol. 47(11):1526-38, 2017
                                                                                      8. Cohen SA et al: Examining trends in the treatment of ureterocele yields no definitive solution. J Pediatr Urol. 11(1):29.e1-6, 2015
                                                                                      9. Adeb M et al: Magnetic resonance urography in evaluation of duplicated renal collecting systems. Magn Reson Imaging Clin N Am. 21(4):717-30, 2013
                                                                                      10. Debenedectis CM et al: Incidental genitourinary findings on obstetrics/gynecology ultrasound. Ultrasound Q. 28(4):293-8, 2012
                                                                                      11. Jesus LE et al: Clinical evolution of vesicoureteral reflux following endoscopic puncture in children with duplex system ureteroceles. J Urol. 186(4):1455-8, 2011
                                                                                      12. Pohl HG: Recent advances in the management of ureteroceles in infants and children: why less may be more. Curr Opin Urol. 21(4):322-7, 2011
                                                                                      13. Lewis JM et al: Complete excision or marsupialization of ureteroceles: does choice of surgical approach affect outcome?. J Urol. 180(4 Suppl):1819-22; discussion 1822-3, 2008
                                                                                      14. Singh I: Adult bilateral non-obstructing orthotopic ureteroceles with multiple calculi: endoscopic management with review of literature. Int Urol Nephrol. 39(1):71-4, 2007
                                                                                      15. Byun E et al: A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. J Urol. 176(4 Pt 2):1871-7; discussion 1877, 2006
                                                                                      16. Merlini E et al: Obstructive ureterocele-an ongoing challenge. World J Urol. 22(2):107-14, 2004
                                                                                      17. Berrocal T et al: Anomalies of the distal ureter, bladder, and urethra in children: Embryologic, radiologic, and pathologic features. RadioGraphics 22: 1139-1164; 2002
                                                                                      18. Shokeir AA et al: Ureterocele: an ongoing challenge in infancy and childhood. BJU Int. 90(8):777-83, 2002
                                                                                      19. Walsh PC et al: Campbell's Urology. 8th ed. Saunders. 2007-52, 2002
                                                                                      20. Chertin B et al: Endoscopic puncture of ureterocele as a minimally invasive and effective long-term procedure in children. Eur Urol. 39(3):332-6, 2001
                                                                                      21. Davidson AJ et al: Radiology of the kidney and genitourinary tract. 3rd ed. Saunders. 213-6, 1999
                                                                                      22. Bellah RD et al: Ureterocele eversion with vesicoureteral reflux in duplex kidneys: findings at voiding cystourethrography. AJR Am J Roentgenol. 165(2):409-13, 1995