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GYNAECOLOGY AND OBSTETRICS IMAGING Table of Contents   
Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 823-824
Antenatal ultrasound diagnosis of ureterocele


Department Of Ultrasonography, Balku's Scan, Pvs Hospital, Calicut -673 002, Kerala, India

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Date of Submission20-Mar-2006
Date of Acceptance10-Aug-2006
 

   Abstract 

The ultrasonographic detection of fetal hydronephrosis demands a thorough search for the presence of ureterocele. This case illustrates a classical unilateral ureterocele diagnosed at 30 weeks of gestation. The pregnancy was uneventful ending in normal vaginal delivery. The neonatal cystoscopic findings supported the definitive antenatal diagnosis.

Keywords: Fetal ureterocele, antenatal ultrasound diagnosis, fetal urinary tract anomalies

How to cite this article:
Balakumar K. Antenatal ultrasound diagnosis of ureterocele. Indian J Radiol Imaging 2006;16:823-4

How to cite this URL:
Balakumar K. Antenatal ultrasound diagnosis of ureterocele. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 24];16:823-4. Available from: http://www.ijri.org/text.asp?2006/16/4/823/32358

   Introduction Top


The fetal ureterocele is occasionally reported as a cause of unilateral or bilateral hydronephrosis. The diagnosis is more specific with high-resolution ultrasound machines as illustrated by the following case. It helps to plan the antenatal or postnatal investigational and interventional procedures at the apt time.


   Case report Top


A primigravida was referred for routine ultrasound scanning at 30 weeks of gestation. Scanning (using Aloka Prosound 5000, 2.5-5 MHz probe) showed normal placental echoes and a fetus with normal biometry. The liquor volume was normal for this period of gestation. The left kidney was severely hydronephrotic (grade IV) along with a tortuous hydroureter. The urinary bladder volume was normal, and it showed periodical emptying. A thin walled smooth cystic projection of 26 mm diameter was seen with in the bladder ('cyst within the cyst' appearance), inseparable from the left vesical wall. Reassessment after few minutes showed the partially emptied bladder enclosing the smooth cystic mucosal projection. The posterior urethra showed no dilation. The right kidney and the ureter were normal. There was no evidence of a double collecting system on either side. These features were typical of an ureterocele causing unilateral ureterohydronephrosis. Further careful scrutiny revealed no other associated anomaly.


   Discussion Top


The ureterocele results from submocosal cystic dilation of the distal ureter and is four times more common among the females [1],[2]. This may present as intravesical or extravesical dilation with or with out hydroureter or hydronephrosis. Often associated with duplex kidneys (ectopic ureterocele), the upper moiety of the involved kidney may show associated stasis along with hydroureter. This case was showing no definite evidence of duplex kidneys. The classical sign of a 'cyst with in a cyst' was demonstrable when the fetal bladder was full. This finding together with ipsilateral ureterohydronephrosis was diagnostic of ureterocele. The antenatal diagnosis of ureterocele by ultrasonography is more specific, if the classical sign of 'a cyst with in a cyst' is defined [3]. If the fetal bladder is empty, the diagnosis is likely to be missed [4].

Ureterocele shows a predilection for the left side [2] with bilateral involvement in 10 - 15 % [5]. The differential diagnoses may include ectopic ureter, prolapsed ureter, bladder diverticulum, mesonephric duct cyst and urethral polyp. This patient had normal volume of amniotic fluid, as the obstruction was unilateral. In those cases of large or bilateral involvement causing anhydramnios, percutaneous needle decompression (fetal vesicoamniotic shunt) may restore normal amniotic fluid volume [6]. The other antenatal treatment options are endoscopic laser ablation or colander perforation of the ureterocele [7].

The classical 'cobra head sign' ('adder head sign') on urography is diagnostic of ureterocele after birth. A detailed postnatal work up including scintigraphy is necessary for proper evaluation to avoid future renal complications [8].

 
   References Top

1.Scherz HC, Kapplan GW, Packer MG, and Brock WA: Ectopic ureteroceles: surgical management with preservation of continence- review of 60 cases. Urology 1989;142: 538-541.  Back to cited text no. 1    
2.Mandell J, Colodny AH, Lebowitz R, et al. Ureteroceles in infants and children. J Urol 1980; 123 (6): 921-926.  Back to cited text no. 2    
3.Ganesh Raj, Weiner JS, Leder RA. Ureterocele in eMedicine. Com, Inc. updated Nov 22, 2002.   Back to cited text no. 3    
4.Winters WD, Lebowitz RL. Importance of prenatal detection of hydronephrosis of the upper pole. AJR 1990;155: 125-129.  Back to cited text no. 4  [PUBMED]  
5.Fleisher AC, Romero R, Manning FA et al. The principles and practice of ultrasonography in obstetrics and gynecology. Appleton & Lange, Norwalk, Connecticut, 1988, pp 266-267.  Back to cited text no. 5    
6.Hansen WF, Cooper CS, Yankowitz J. Ureterocele causing anhydramnios successfully treated with percutaneous needle decompression. Obstet Gynecol 2002; 95(5Pt2): 953-956.  Back to cited text no. 6    
7.Ashmead GG, Mercer B, Herbst M et al. Fetal Bladder Outlet Obstruction Due to Ureterocele. In Utero "Colander" Therapy. J Ultrasound Med 2004; 23: 565-568.   Back to cited text no. 7    
8.Connolly LP, Connolly SA, Prubach LA et al. Ectopic ureteroceles in infants with prenatal hydronephrosis: use of renal cortical scintigraphy. Cli Nucl Med 2002; 27 (3): 169-175.  Back to cited text no. 8    

Top
Correspondence Address:
K Balakumar
Balku's Scan, Railway Station Road, Pvs Hospital, Calicut 673 002, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32358

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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    Abstract
    Introduction
    Case report
    Discussion
    References
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