Radiographic features of ureterocele.

Abstract

Ureterocele, from the Greek (όυρητήρ and κήλη), literally means hernia of the ureter. It is the result of a congenital stenosis of the ureteral orifice and a concomitant weakness of the wall of the lower ureter so that there is a resultant ballooning of the terminal ureter into the bladder. This intracystic ballooning of the dilated ureter produces a characteristic defect on the cystogram, which is practically pathognomonic in the infant. The extent of the radiographic defect is proportional to the size of the ureterocele, which may vary from a centimeter in diameter to sizes which fill the bladder and may occasionally, in the female, prolapse through the urethra. Because of obstruction secondary to the ureterocele there is frequently an associated hydronephrosis on the affected side. Of the anomalies concomitant with ureterocele, double ureter is the most common. When this latter anomaly is present, the ureterocele usually affects the ureter draining the upper kidney. Ureteroceles may also contain calculi. The sex incidence of ureterocele is not proved, though some observers report a greater incidence in females. There is no predilection as to location on the right or left side. Radiographically ureterocele appears as a round, constant filling defect at the ureteral orifice. On occasion, with intravenous urography, the thickness of the ureterocele wall will form a non-opaque halo or cobra head, with contrast substance in the ureter, ureterocele, and bladder. When stones are present they lie within this halo. In the practice of the pediatric urologist ureterocele is not rare (Campbell reports 1 in 30 cases of chronic pyelitis) but in a general x-ray department the lesion is not often seen. Ureterocele should be suspected when the radiographic signs described above are present. Once the condition is suspected, it is in the province of the urologist to make the final diagnosis and to prescribe treatment. There are no cardinal signs or symptoms of ureterocele other than complaints referable to the genitourinary tract. Dysuria is most commonly the chief complaint on the part of the younger patients. In the adult the symptoms are those due to the secondary hydronephrosis. We present five proved cases of ureterocele demonstrating the typical radiographic findings. These findings are sufficiently pathognomonic that the diagnosis can be readily made by intravenous urography, especially in the infant, without the aid of cystoscopy or retrograde pyelography.