Prolapsed Ureterocele
Prolapsing ureterocele is typically a disorder encountered in girls. It is one of few such that can present as a bladder outlet obstruction. The ureterocele presents as an interlabial mass that is often interpreted as being vaginal but in distinction to other interlabial masses such as rhabdomyoscarcoma, it is smooth and pink. The ureterocele is associated with the upper pole moiety of a duplex kidney 90% of the time. It represents a dilated intravesicular component of the ureter inserting ectopically just above the bladder neck, During micturition the dilated ureterocele slides down the posterior wall of the bladder neck and into the proximal urethra. This causes varying degrees of obstruction and the resultant urinary retention may present emergently. A so-called sliding ureterocele may present later and be the result of a very large more typically located simple ureterocele. Distal ureteral calculi might also be seen. VCUG is the study of choice to image the ureterocele. It will demonstrate the location of the mass at the bladder neck, the degree of obstruction, and the dynamic nature of the obstruction during voiding. Bladder muscle hypertrophy may be encountered, as can contra- and ipsilateral vesico-ureteral reflux. Treatment consists of incision of the ureterocele near its bladder insertion, however due to vesicureteric reflux, marsupialization and reimplantation are most often required. Because of the frequency of obstruction, ultrasound of the upper tracts is recommended for further evaluation. A differential diagnosis will include bladder rhabdomyosarcoma, urethral polyp, and hydrometrocolpos. Reference: Campbell’s Urology 9th ed: Jayanthi VR, Koff SA. Long-term outcome of transurethral puncture of ectopic ureteroceles: initial success and late problems. Journal of Urology 1999 Sept: 162(3 Pt2) 1077-80
A. Large prolapsing ureterocele
B. Membranous urethra
C. Distal urethra
B
A
C
Differential Diagnosis
(Click on the image to go to a specific discussion)
Polyp