Ureterocele – a duplex anamoly
In a human body, kidneys filters and removes waste matter and excess water from the blood. This waste is transferred to the urinary bladder through ‘ureters’. In normal conditions, one kidney will have one ureter connected to the bladder. In the lower side of the bladder, there will be another tube called ‘urethra’ to expel the urine out from the bladder. In rare (less than 1%) of people, there will be 2 ureters connected from the kidney to the urinary bladder. This is called ‘duplex anamoly’. This duplicate ureter can cause different types of medical conditions like swelling at the end where it connects to the bladder (called Ureterocele), can have improper valve functionality as a result of which urine will be returned to kidneys etc.
Ureterocele is a congenital (birth) defect. This is more often seen in girls than in boys. Usually this shows different symptoms by the age of 2. A good urologist after performing a few tests can figure out the problem and treat the problem permanently with a surgery.
When there are two ureters, one often doesn’t develop like normal one. The end of the ureter where it connects to the bladder may not be properly connecting to the bladder. As a result of this, the urine gets collected at the end of the ureter and this becomes like a balloon, sometimes occupying the entire bladder. In case when the duplicate ureter is developed well and connected well to the bladder, if the valve inside it is weak or not formed correctly, the urine collected inside the bladder starts going back to the kidneys. This condition is called ‘Vesicoureteral Reflux (VUR)’. In even rare cases, both kidneys can have dual ureters. (Bilateral Ureterocele).
What happens because of Ureterocele
- Kidney damage
- Kidney Infection
- Chances of Kidney stone formation
- In girls, the ballooning can protrude outside the urethra.
Symptoms of Ureterocele
In not so severe conditions, no symptoms may be seen. If there are any symptoms, they can be
- Side, back or abdominal pain
- UTI – Urinary Tract Infections
- Painful Urination
- Bad Smelling Urine
- Hematuria – Blood in Urine
Diagnosis of Ureterocele
In many cases, ureterocele condition will be seen before the birth of the child but it may not be diagnosed or treated until it causes a problem such as Kidney infection or Urinary Tract Infection.
Ultrasound tests will be performed to figure out the condition . A Voiding Cystourethrogram (Cysto-Urethro-Gram) (VCUG) may be done by the urologist to see how the bladder is functioning. This test is done by filling the bladder with a special gel and a series of X-rays will be taken to see how the gel is being expelled out of the body through the bladder.
Once the doctor figures out exactly what is happening inside the bladder, he/she will also check the kidneys for possible infections and malfunctions. This is an important step. If any of these tests do not give a proper picture, the doctor may ask you to get an MRI done.
Treatment of Ureterocele
What needs to be done will decided by the urologist depending on the condition, age of the patient, effect on kidneys and presence of urine reflux condition. At times, multiple surgeries or combination of surgeries may need to be done.
In this treatment, the ureterocele (ballooned part) is punctured and decompressed. This procedure is done using a cystoscope and works only if the wall of the ureterocele is thinner. If it is thick, an open surgery needs to be done through an incision in the abdomen area.
Upper Pole Nephrectomy
If the upper half of a kidney is not functioning and if there is no urine reflux, the non working part of the kidney will be removed either laparoscopically or through a cut under the ribs.
If entire kidney is not functioning, it has to be removed laparoscopically or by making a small incision.
Removal of the ureterocele and ureteral reimplantation
In this procedure, a small cut is made in the lower abdomen. The bladder is opened and ureterocele is removed. The floor, neck of the bladder are rebuilt and the ureteral flap valve is recreated to prevent urine reflux.
Ureteropyelostomy or Upper to Lower Ureteroureterostomy
If the upper part of the ureter is working well and there is no reflux with it’s lower part (good valve functioning), then, instead of removing the ureter, the obstructed part is connected to the non-obstructed part of the other ureter or kidney.