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Ureterocele
Ashish P. Wasnik, MD, FSAR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Balloon-like, thin-walled, cystic dilatation of intramural portion of distal ureter bulging into bladder
            • Orthotopic ureterocele (intravesical, less common): Normal ureteral insertion at trigone
              • Single ureter system
              • Bilateral in ~ 30% of cases
            • Ectopic ureterocele (extravesical, more common): Inserts below trigone
              • Duplicated collecting system in 80% of cases
                • Upper moiety ureter often inserts medial and distal to superior moiety ureter
                • Male: Insertion at bladder neck, prostatic urethra, vas deferens, or seminal vesicle
                  • Insertion always above external sphincter → no urine leak/wetting
                • Female: Insertion in distal urethra, vaginal vestibule, vagina, cervix, uterus, or fallopian tube
                  • If insertion below external sphincter → urine leak/wetting
              • Single nonduplicated system in 20% of cases
                • Small/poorly functioning kidney (often from chronic reflux), may be invisible on imaging
              • Cecoureterocele: Ectopic submucosal ureterocele extending to urethra with intravesical opening

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Radiographic Findings

                • CT Findings

                  • MR 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

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Czarniecki M et al: Case 267: Cecureterocoele manifesting in a man with infertility. Radiology. 292(1):263-6, 2019
                                            2. 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
                                            3. 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
                                            4. Shebel HM et al: Cysts of the lower male genitourinary tract: embryologic and anatomic considerations and differential diagnosis. Radiographics. 33(4):1125-43, 2013
                                            5. Esfahani SA et al: Precise delineation of ureterocele anatomy: virtual magnetic resonance cystoscopy. Abdom Imaging. 36(6):765-70, 2011
                                            6. Taori K et al: Prolapsed simple ureterocele: evaluation by transvaginal voiding sono-urethrography. J Clin Ultrasound. 39(9):544-7, 2011
                                            7. Zougkas K et al: Assessment of obstruction in adult ureterocele by means of color Doppler duplex sonography. Urol Int. 75(3):239-46, 2005
                                            8. Bolduc S et al: The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles. BJU Int. 91(7):678-82, 2003
                                            9. do Nascimento H et al: Magnetic resonance in diagnosis of ureterocele. Int Braz J Urol. 29(3):248-50, 2003
                                            10. Shimoya K et al: Diagnosis of ureterocele with transvaginal sonography. Gynecol Obstet Invest. 54(1):58-60, 2002
                                            11. Madeb R et al: Evaluation of ureterocele with Doppler sonography. J Clin Ultrasound. 28(8):425-9, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Diagnostic Checklist

                                                    TERMINOLOGY

                                                    • Definitions

                                                      • Balloon-like, thin-walled, cystic dilatation of intramural portion of distal ureter bulging into bladder
                                                      • Orthotopic ureterocele (intravesical, less common): Normal ureteral insertion at trigone
                                                        • Single ureter system
                                                        • Bilateral in ~ 30% of cases
                                                      • Ectopic ureterocele (extravesical, more common): Inserts below trigone
                                                        • Duplicated collecting system in 80% of cases
                                                          • Upper moiety ureter often inserts medial and distal to superior moiety ureter
                                                          • Male: Insertion at bladder neck, prostatic urethra, vas deferens, or seminal vesicle
                                                            • Insertion always above external sphincter → no urine leak/wetting
                                                          • Female: Insertion in distal urethra, vaginal vestibule, vagina, cervix, uterus, or fallopian tube
                                                            • If insertion below external sphincter → urine leak/wetting
                                                        • Single nonduplicated system in 20% of cases
                                                          • Small/poorly functioning kidney (often from chronic reflux), may be invisible on imaging
                                                        • Cecoureterocele: Ectopic submucosal ureterocele extending to urethra with intravesical opening

                                                    IMAGING

                                                    • General Features

                                                      • Ultrasonographic Findings

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR 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

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Czarniecki M et al: Case 267: Cecureterocoele manifesting in a man with infertility. Radiology. 292(1):263-6, 2019
                                                                                      2. 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
                                                                                      3. 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
                                                                                      4. Shebel HM et al: Cysts of the lower male genitourinary tract: embryologic and anatomic considerations and differential diagnosis. Radiographics. 33(4):1125-43, 2013
                                                                                      5. Esfahani SA et al: Precise delineation of ureterocele anatomy: virtual magnetic resonance cystoscopy. Abdom Imaging. 36(6):765-70, 2011
                                                                                      6. Taori K et al: Prolapsed simple ureterocele: evaluation by transvaginal voiding sono-urethrography. J Clin Ultrasound. 39(9):544-7, 2011
                                                                                      7. Zougkas K et al: Assessment of obstruction in adult ureterocele by means of color Doppler duplex sonography. Urol Int. 75(3):239-46, 2005
                                                                                      8. Bolduc S et al: The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles. BJU Int. 91(7):678-82, 2003
                                                                                      9. do Nascimento H et al: Magnetic resonance in diagnosis of ureterocele. Int Braz J Urol. 29(3):248-50, 2003
                                                                                      10. Shimoya K et al: Diagnosis of ureterocele with transvaginal sonography. Gynecol Obstet Invest. 54(1):58-60, 2002
                                                                                      11. Madeb R et al: Evaluation of ureterocele with Doppler sonography. J Clin Ultrasound. 28(8):425-9, 2000