Prolapse of ureterocele through the urethra is rare. To our knowledge, the following is the first case report of prolapsing ureterocele in a male and is of special interest because the lesion was demonstrated only by ciné voiding cystourethrography. In 1944 Emmett and Logan (5) in a rather comprehensive review of the literature found only 37 cases, all in females. Since that time several other cases have been reported (2, 8–10), all in females. In most of these patients the prolapsed ureterocele presented through the external meatus. There has been some controversy in respect to the optimal method of recording the voiding cystourethrogram. Some authors (4, 11) maintain that serial spot-films with conventional image-intensification fluoroscopy give adequate information at relatively low dose and furnish better detail than do ciné studies. Advocates of the cineradiographic method, on the other hand, claim that motion studies permit evaluation of dynamic phenomena (6). Our approach combines the advantages of both methods. For several years we have used a combination of 70 mm spot-films, kinescope, and videotape recording. The kinescope is a device in which the movie camera photographs the image displayed on a television monitor, rather than the output phosphor of an image-intensifier tube as in conventional cineradiography. Thus, the radiation level is the same as for television fluoroscopy, and the high radiation dose of conventional cineradiography is avoided. Although the detail on the movie from the kinescope is not as good as in conventional cineradiography, it is quite satisfactory for evaluation of transient phenomena. Seventy-millimeter spot-films obtained from the image-intensifier phosphor require about one-fifth of the radiation dosage needed for conventional spot-films, are easier to obtain in rapid sequence than the conventional studies, and are useful for evaluation of fine detail. Videotape recording serves several purposes in voiding cystourethrography. It allows the fluoroscopist immediate review of the procedure completed and serves as insurance that in event of failure in kinescope or ciné processing system, another movie can be obtained from the tape. A 15-year-old boy presented with a one- to two-year history of dysuria. He reported considerable pain and cessation of the stream after initiation of voiding, but after several seconds voiding could be reinitiated. The sequence would be repeated several times during each act of voiding. A simple right ureterocele was seen in the bladder on the excretory urogram. The spot-films of the urethra obtained during voiding cystourethrography were unremarkable. Review of the ciné portion of the study showed that the ureterocele descended from the bladder into the posterior urethra during full voiding; it then remained in the urethra for only a few seconds before returning into the bladder. At cystoscopy a large right simple ureterocele was seen. It was unroofed and promptly collapsed. Postoperatively no infection or other urinary difficulty was noted, and a postoperative ciné voiding cystourethrogram showed no evidence of reflux or other abnormality. Discussion Masses in the posterior urethra are uncommon. Mobile masses are particularly rare. Probably the only lesion which could be confused with prolapsing ureterocele would be a pedunculated polyp (7). A radiolucent urethral calculus (3) or foreign body might also be considered in the differential diagnosis. An ectopic ureterocele inserting into the urethra may present as a urethral mass (1) and could be confused with a prolapsing simple ureterocele. Summary A case of simple ureterocele prolapsing into the urethra of a 15-year-old boy is described. The lesion was apparent only on cineradiography. The combination of 70 mm spot-filming and kinescope cineradiography offers an accurate, convenient technic of voiding cystourethrography with lower dosage to the patient than in conventional cineradiography.
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