Bilateral Ureterocele

Abstract

THE FOLLOWING case of bilateral ureterocele is believed to be of interest because it further confirms the very favorable— in this case dramatic—results 0 btained with conservative transurethral fulguration. In addition, it was possible to obtain very satisfactory roentgenograms of the anomalies by a modification of the routine method. The diagnostic and therapeutic measures were performed aboard a United States Navy Hospital Ship. A ureterocele is a saccular dilatation of the lower end of the ureter into the bladder. It is usually considered to be the result of increased intraureteral pressure acting against a combination of two congenital anomalies: atresia or stenosis of the ureteral orifice and a deficiency of connective-tissue attachment (Waldeyer's sheath) of the ureter to the bladder. The characteristic roentgen finding in ureterocele is a cystic ballooning or spherical dilatation of the lower end of the ureter as seen on intravenous urography or retrograde pyelography. The cystogram may show a spherical filling defect in the region of the ureteral orifice. In addition, evidence of obstructive uropathy, including dilatation of the renal pelvis and blunting and clubbing of the calices, may be noted on the affected side. While ureteroceles are relatively frequent urological anomalies Herman (5) states that they are bilateral in only 10 per cent of cases. Gutierrez (4) and Thompson and Greene (7) have shown that for the ureterocele of average size transurethral fulguration through the entire thickness of its wall is a satisfactory method for enlarging the stenosed ureteral orifice. It is also the consensus of opinion that with bilateral ureteroceles only one should be treated at a time. Case Report An 18-year-old white seaman was admitted to the urological service of the hospital ship from an aircraft carrier on March 1, 1947, complaining of “blood in the urine” of seven days duration. He gave a history of intermittent gross hematuria accompanied by burning but no pain. The blood was described as being throughout the urinary stream. No blood clots were observed. Four days before admission the bleeding stopped spontaneously. At that time a vague suprapubic discomfort was noticed. Nearly two years earlier the patient had an acute non-specific urethritis, which was treated successfully with sulfadiazine. For the past year he had had slight difficulty initiating the urinary stream. The family history revealed that his mother had “kidney disease” many years ago, from which she had apparently recovered uneventfully. On admission to the hospital ship, the patient was completely asymptomatic except for slight difficulty in starting the. urinary stream. The only positive finding on physical examination was a slightly boggy left lateral lobe of the prostate, indicating a lowgrade chronic prostatitis.