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Ureterocele
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Synonyms

          • Bladder cyst, cobra head ureter
        • Definitions

          • Congenital cystic dilation of distal submucosal portion of 1 or both ureters within urinary bladder
          • Categorized according to ureterocele position
            • Intravesical: Completely contained within urinary bladder
            • Extravesical: Partially extends into bladder neck, urethra, or perineum
          • Categorized according to ureterocele insertion
            • Orthotopic (simple): Orifice located in normal anatomic position in bladder trigone
            • Ectopic: Orifice located anywhere else
              • Ectopic ureter may drain to other genitourinary locations without ending as ureterocele
          • Categorized according to type of kidney drained
            • Single system ureterocele: Kidney gives rise to single collecting system with solitary ureter
              • Typically simple, intravesical ureterocele
            • Duplex system ureterocele: Kidney has completely duplicated collecting system with 2 complete ureters
              • 1 ureteral insertion ectopic by definition (often extravesical ureterocele)
          • Cecoureterocele: Unique subtype elongated beyond ureteral orifice by tunneling under trigone & urethra
          • Any type of ureterocele may become obstructed & cause hydronephrosis

        IMAGING

        • General Features

          • Radiographic Findings

            • Fluoroscopic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Nuclear Medicine Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    Selected References

                                    1. Cohen SA et al: Examining trends in the treatment of ureterocele yields no definitive solution. J Pediatr Urol. 11(1):29.e1-6, 2015
                                    2. Gander R et al: Evaluation of the initial treatment of ureteroceles. Urology. 89:113-7, 2015
                                    3. Sarsu SB et al: Multiple stones in a single-system ureterocele in a child. APSP J Case Rep. 6(2):19, 2015
                                    4. Timberlake MD et al: Minimally invasive techniques for management of the ureterocele and ectopic ureter: upper tract versus lower tract approach. Urol Clin North Am. 42(1):61-76, 2015
                                    5. Torres Montebruno X et al: Fetoscopic laser surgery to deobstruct a prolapsed ureterocele. Ultrasound Obstet Gynecol. 46(5):623-6, 2015
                                    6. 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
                                    7. Swana HS et al: Transurethral neo-orifice (TUNO) a novel technique for management of upper pole obstruction in infancy. Int Braz J Urol. 39(1):143, discussion 144, 2013
                                    8. Payabvash S et al: Application of magnetic resonance urography in diagnosis of congenital urogenital anomalies in children. Pediatr Surg Int. 24(9):979-86, 2008
                                    9. Sozubir S et al: Prenatal diagnosis of a prolapsed ureterocele with magnetic resonance imaging. Urology. 62(1):144, 2003
                                    10. Berrocal T et al: Anomalies of the distal ureter, bladder, and urethra in children: Embryologic, radiologic, and pathologic features. RadioGraphics 22: 1139-1164; 2002
                                    11. Chavhan GB: The cobra head sign. Radiology. 225(3):781-2, 2002
                                    12. Keesling CA et al: Sonographic appearance of the bladder after endoscopic incision of ureteroceles. AJR Am J Roentgenol. 170(3):759-63, 1998
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Bladder cyst, cobra head ureter
                                          • Definitions

                                            • Congenital cystic dilation of distal submucosal portion of 1 or both ureters within urinary bladder
                                            • Categorized according to ureterocele position
                                              • Intravesical: Completely contained within urinary bladder
                                              • Extravesical: Partially extends into bladder neck, urethra, or perineum
                                            • Categorized according to ureterocele insertion
                                              • Orthotopic (simple): Orifice located in normal anatomic position in bladder trigone
                                              • Ectopic: Orifice located anywhere else
                                                • Ectopic ureter may drain to other genitourinary locations without ending as ureterocele
                                            • Categorized according to type of kidney drained
                                              • Single system ureterocele: Kidney gives rise to single collecting system with solitary ureter
                                                • Typically simple, intravesical ureterocele
                                              • Duplex system ureterocele: Kidney has completely duplicated collecting system with 2 complete ureters
                                                • 1 ureteral insertion ectopic by definition (often extravesical ureterocele)
                                            • Cecoureterocele: Unique subtype elongated beyond ureteral orifice by tunneling under trigone & urethra
                                            • Any type of ureterocele may become obstructed & cause hydronephrosis

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • Fluoroscopic Findings

                                                • Ultrasonographic Findings

                                                  • MR Findings

                                                    • Nuclear Medicine Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      Selected References

                                                                      1. Cohen SA et al: Examining trends in the treatment of ureterocele yields no definitive solution. J Pediatr Urol. 11(1):29.e1-6, 2015
                                                                      2. Gander R et al: Evaluation of the initial treatment of ureteroceles. Urology. 89:113-7, 2015
                                                                      3. Sarsu SB et al: Multiple stones in a single-system ureterocele in a child. APSP J Case Rep. 6(2):19, 2015
                                                                      4. Timberlake MD et al: Minimally invasive techniques for management of the ureterocele and ectopic ureter: upper tract versus lower tract approach. Urol Clin North Am. 42(1):61-76, 2015
                                                                      5. Torres Montebruno X et al: Fetoscopic laser surgery to deobstruct a prolapsed ureterocele. Ultrasound Obstet Gynecol. 46(5):623-6, 2015
                                                                      6. 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
                                                                      7. Swana HS et al: Transurethral neo-orifice (TUNO) a novel technique for management of upper pole obstruction in infancy. Int Braz J Urol. 39(1):143, discussion 144, 2013
                                                                      8. Payabvash S et al: Application of magnetic resonance urography in diagnosis of congenital urogenital anomalies in children. Pediatr Surg Int. 24(9):979-86, 2008
                                                                      9. Sozubir S et al: Prenatal diagnosis of a prolapsed ureterocele with magnetic resonance imaging. Urology. 62(1):144, 2003
                                                                      10. Berrocal T et al: Anomalies of the distal ureter, bladder, and urethra in children: Embryologic, radiologic, and pathologic features. RadioGraphics 22: 1139-1164; 2002
                                                                      11. Chavhan GB: The cobra head sign. Radiology. 225(3):781-2, 2002
                                                                      12. Keesling CA et al: Sonographic appearance of the bladder after endoscopic incision of ureteroceles. AJR Am J Roentgenol. 170(3):759-63, 1998