Ureterocele (Pediatric)
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What is a ureterocele?
A ureterocele involves the kidney, ureter, and bladder. A normal ureter transports urine from the kidney to the bladder. When a child has a ureterocele, the portion of the ureter closest to the bladder enlarges because the ureter opening is abnormal and obstructs urine outflow. The urine then backs up in the ureter tube.
What is ureteral duplication?
Children with a ureterocele may also have ureteral duplication: two ureters for one kidney with each draining independently into the bladder. The ureter with the ureterocele generally drains the top half of the kidney while the duplicate drains the lower half. However, the ureter with the ureterocele may enter the bladder at a lower point, causing obstruction of urine.
Who is affected by ureterocele and ureteral duplication?
Ureterocele and ureteral duplication are more common in females than in males. In females, the ureterocele often involves both kidneys. In males, generally one kidney is involved.
What causes ureterocele and ureteral duplication?
The causes of ureterocele and ureteral duplication are unknown, however, some cases have been reported in siblings, suggesting a genetic component.
How is a ureterocele or a duplicate ureter diagnosed?
If a ureterocele goes undetected on a prenatal ultrasound, it may not be seen until the child has recurrent urinary tract infections. If your child has a history of frequent urinary tract infections, a doctor may order these diagnostic imaging procedures:
- Ultrasound of the entire urinary tract uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function and to assess blood flow through the vessels.
- Voiding cystourethrogram (VCUG) uses an X-ray to view structures of the urinary tract. A catheter is placed into the bladder and contrast dye is instilled. A VCUG also reveals reflux, the size and location of the ureterocele, and the drainage of the urinary tract.
What is the treatment for a ureterocele?
Treatment is complex and customized and varies by child. We determine specific treatment for ureterocele or ureteral duplication based on:
- child's age, overall health, and medical history
- child's tolerance for specific medications, procedures, or therapies
- expectations for the course of the condition
- extent of the condition
- your opinion or preference
If your child is ill from an urinary tract infection, intravenous fluids and antibiotics may be administered. Once the urinary tract infection is resolved, the ureterocele will be addressed.
Treatment of ureterocele often depends on the size and location of the ureterocele and the function of the kidney drained by the ureter. If the area of the ureter has a lot of urine accumulation, it may need to be surgically drained. Larger ureteroceles that are associated with reflux (or backflow) into a ureter may be removed. If there is a duplicate ureter, the duplicate may be left intact.
In some children, the kidney of the affected side may be damaged and part of it may be removed. A small ureterocele may not require medical intervention if the kidney functions without difficulty. These options will be discussed with our pediatric urology team.