Ureteral jet phenomenon; stream of opaque medium simulating an anomalous configuration of the ureter.

Abstract

Excretory urograms made in the course of routine urologic study of two girls with recurrent urinary tract infections showed an unusual configuration of the terminal left ureters. These ureters appeared to cross the mid-line and terminate in the region of the trigone on the opposite side of the bladder. Findings on subsequent cystoscopic examination and retrograde pyelography in each case were entirely normal. We have not encountered any mention of this roentgenographic finding in the literature. Personal communication with other urologists and radiologists confirms the rarity of the observation. Case Reports Case I: A 5-year-old white girl had experienced several bouts of pyuria associated with high fever, which responded well to antibiotic therapy. The causative organism was usually a micrococcus (Staphylococcus), coagulase-positive. In December 1953, following a typical attack of urinary tract infection, an excretory urogram was obtained with 15 c.c. of 30 per cent Urokon. The left ureter showed what appeared to be an anomalous termination in the urinary bladder (Fig. 1). At cystoscopy the trigone appeared normal, the vesical neck was thought to be mildly obstructed, and there was minimal trabeculation of the bladder. Retrograde study revealed a normal left ureter (Fig. 3). This patient was treated conservatively with repeated urethral dilatations and intermittent chemotherapy. Case II: A girl of 3½ years had a history of recurrent urinary tract infections, with high fever complicated by generalized convulsive seizures. The infections were due to E. coli. In January 1953, the upper urinary tract was found to be normal on intravenous pyelography. Because of continuing infections the urinary tract was again examined in February 1954. An excretory urogram, obtained with 15 c.c. of 30 per cent Urokon, showed an anomalous terminal left ureter (Fig. 2) quite similar to that in Case I. On cystoscopy the trigone appeared normal, but there was mild trabeculation of the bladder secondary to a vesical neck obstruction. A left retrograde pyelogram showed a normal terminal ureter (Fig. 3). This patient was treated by transurethral resection of the vesical neck. Comment The unusual urographic finding in these two cases is thought to be the result of making the roentgenogram just as a bolus of contrast medium was being ejected from the ureteral orifice. This ureteral jet of highly concentrated radiopaque medium streamed across the trigone, giving the appearance of a prolonged ureter opening on the opposite side of the bladder. Subsequent cystoscopy and retrograde pyelography demonstrated a normal ureteral termination in each instance. The age of these patients, the infections, and the vesical neck obstructions might be considered as possibly contributing to this unusual observation. This ureteral jet urographic phenomenon is reported simply as a curiosity, in the realization that others will see and perhaps be puzzled by it.