Ureterocele

What is a ureterocele?

A ureterocele is a congenital condition (something you’re born with) that causes the bottom of your ureter to bulge like a balloon inside your bladder. Your ureters are tubes that carry your pee from your kidney to your bladder. A ureterocele blocks the flow or urine (pee), which can lead to pee backing up to your kidneys (vesicoureteral reflux). Ureteroceles can vary in size and can cause different symptoms depending on the type and location.

Types of ureterocele

A ureterocele can affect one ureter (unilateral ureterocele) or both ureters (bilateral ureterocele). A unilateral ureterocele is the more common type.

Healthcare providers can also classify a ureterocele depending on its location. Most ureteroceles are extravesical (up to 75% of cases). Extravesical ureterocele is most common in infants and children. It means the bulge extends to the bottom of the bladder (bladder neck) and to the urethra.

Ureteroceles can also be intravesical (less than 25% of all cases). With this type, the bulge appears just inside your bladder and doesn’t extend to the bladder neck or outside your bladder.

How common is a ureterocele?

A ureterocele occurs in about 1 in 5,000 to 1 in 12,000 children. It’s more common in people assigned female at birth (AFAB).

What are the symptoms of a ureterocele?

Ureteroceles often don’t have any symptoms, unless the condition causes a urinary tract infection (UTI). Symptoms of a UTI include:

• Painful urination and/or burning feeing when you pee.
• Foul-smelling urine.
• Pain or a lump in your abdominal area.
• Blood in your pee.
• Peeing more often.
• Not being able to hold your pee.
• Not being able to fully empty your bladder.

Contact your healthcare provider if you notice any of these symptoms in your child.

What causes a ureterocele?

A ureterocele forms during fetal development when the end of the ureter that enters the bladder doesn’t form correctly. Sometimes, you don’t have symptoms of a ureterocele until you’re an adult, but the cause is still the same.

What are the risk factors for a ureterocele?

There are no risk factors for a ureterocele. Researchers believe it happens randomly. It’s not due to something you (or a birth parent) did incorrectly during pregnancy.

How serious is a ureterocele?

A ureterocele is serious but treatable. Without treatment, a ureterocele can lead to kidney damage and kidney infection.

What are the complications of a ureterocele?

When your pee doesn’t drain from your body (urinary retention), it can back up into your kidneys. This causes a urinary tract infection (UTI), which can lead to kidney damage.

Other risks include:

• Kidney stones.
• Bladder damage.
• Recurring UTIs.

Kidney damage is irreversible, which means once it loses some of its functionality, it doesn’t come back. For that reason, it’s important to receive treatment to preserve kidney function.

How is a ureterocele diagnosed?

Healthcare providers can diagnose many ureteroceles during a prenatal ultrasound. This most often occurs around 20 weeks in pregnancy. A swollen ureter and kidney on the ultrasound may lead your provider to suspect a ureterocele. An imaging test after birth can confirm it. Sometimes, a ureterocele diagnosis doesn’t happen until after birth. But most children with a ureterocele receive a diagnosis by age 2.

However, the condition can still be found in older children and adults who experience kidney stones or a urinary tract infection. Your provider may order any of these tests:

• A kidney ultrasound.
• A bladder test called a voiding cystourethrogram (VCUG).
• A renal scan to evaluate kidney function.
• CT scans (computed tomography scan) and MRIs (magnetic resonance imaging) to view the bladder and kidneys.
• A urine test to check for a urinary tract infection.

How do you fix a ureterocele?

Treatment for a ureterocele depends on:

• When healthcare providers diagnose it.
• Whether it affects your kidneys.
• If there’s vesicoureteral reflux (VUR).

If your pregnancy care provider finds it during a prenatal ultrasound, you may take antibiotics to reduce the chances of infection until surgery happens. Once your child is born, their healthcare provider will determine the best treatment.

Other options for treatment include surgery or watchful waiting.

Surgical treatments

The goal of surgery is to stop the ureter from ballooning and causing a blockage. There are several surgical methods your provider may use:

• Transurethral puncture: This procedure involves puncturing the ureterocele. To do this, a surgeon inserts a cystoscope into the urethra and into the bladder. This procedure can be thought of as popping a balloon. It’s usually an outpatient procedure (so there’s no need for an overnight hospital stay), but still uses general anesthesia (being asleep for surgery).
• Ureteral reimplantation: This procedure involves a surgeon making an incision in the lower abdomen to reach the bladder. The surgeon then removes the ureterocele and reimplants the ureter into the bladder correctly. They also recreate the flap valve to prevent VUR (urine reflux). This surgery is generally more complex but successful about 90% to 95% of the time.
• Upper pole nephrectomy: This surgery happens when the upper part of your kidney isn’t working due to damage from a ureterocele. This is most often for people with a ureterocele and a duplex kidney.

Watchful waiting

Watchful waiting involves a healthcare provider monitoring your condition over time to see how it progresses. This may apply to you if you’re an adult or if your ureterocele isn’t causing any symptoms and there appears to be no kidney damage.

What are the complications of ureterocele surgery?

Surgical treatment to fix a ureterocele is very effective, but all surgeries come with risks. Some of the possible complications of surgery for ureterocele include:

• Bladder perforation or injury.
• Complications from anesthesia.

Can a ureterocele be cured?

Yes, surgical treatment can cure a ureterocele.

Can you prevent a ureterocele?

No, you can’t prevent a ureterocele. It’s sporadic and happens randomly.

What is the outlook for a child with a ureterocele?

The outlook is generally good because the blockage of urine is temporary. If your child has a ureterocele that causes kidney damage, know that the kidney damage is permanent. You can’t fix kidney damage; you can only prevent it from getting worse. That’s why early detection and treatment for a ureterocele is critical. Luckily, healthcare providers can diagnose most cases of ureterocele during pregnancy.

When should I contact my child’s healthcare provider?

Contact your child’s pediatrician if they have symptoms of a UTI, such as:

• Abdominal or flank pain.
• Fever.
• Pain when peeing.
• Cloudy pee or foul-smelling pee.