Kevin E Snyder, M.D.

February 20, 2004

Discussion

Ureteroceles are thought to represent a failure of recanalization of a membrane situated between the distal ureter and bladder. The resulting dilatation of the distal ureter at the UVJ is the visualized ureterocele. A ureterocele may either insert orthotopically or ectopically. The ectopic insertion of a ureterocele is usually accompanied by ureteral duplication. In these cases, the ectopic ureter tends to drain the upper pole moiety of the kidney, and insert inferiorly and medially to the native ureter. This is referred to as the Weigert-Meyer rule. The most common complication of an ectopic ureterocele is obstruction, which may be unilateral but may also extend to obstruct the contralateral ureter. Orthotopic ureteroceles tend to be asymtomatic and discovered incidentally on imaging exams. A larger size of the ureterocele is more likely to be associated with obstruction, particularly those over 2cm. The appearance of a ureterocele as it protrudes into a contrast filled bladder has been referred to as the "cobra head". It is important to recognize a pseudoureterocele vs. a simple orthotopic ureterocele. A pseudoureterocele is the resulting appearance from some underlying pathology, such as an impacted stone or neoplasm. A benign, simple ureterocele should demonstrate a sub - 2mm uniform lucent rim and be smooth and regular throughout. Any deviation from this should suggest an underlying pathologic cause. Operative procedure in this case consisted of partial cystectomy with re-implantation of the right ureter. Diagnosis was Transitional Cell Carcinoma.

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