What is a ureterocele?
A ureterocele is a swelling at the end of the ureter that stops or limits urine flow into the bladder. The urine then backs up in the kidney, causing it to swell like a water balloon. This condition affects girls more often than boys and is present at birth.
In normal development, a child has two kidneys, and ureters drain urine from the kidneys to the bladder. Different types of ureteroceles exist, and each has a distinct presentation, causes different concerns and has unique treatments.
For example, some may have two ureters for one kidney, referred to as ureteral duplication. One ureter drains the top half of the kidney, and the second drains to the bottom half. If the ureter with the out-pouching enters the bladder lower, it may cause a backflow of urine into the higher ureter.
In roughly 1 in 100 births, the kidney develops in two parts (renal duplication), and each has a separate ureter. Most often, the ureters come together into a “Y” shape entering the bladder.
Serious complications may occur if the ureterocele isn’t identified and promptly treated.
Vesicoureteral reflux (VUR) exists when urine flows in reverse from the bladder back to the kidney. A backup of urine causes hydronephrosis or swelling of the kidney. Pooling of urine in the kidneys may cause kidney infections.
How are ureteroceles diagnosed?
Duplications of kidney and/or ureters is generally diagnosed before birth. A routine ultrasound around week 20 of pregnancy often finds evidence of duplication. If there is evidence of duplication, a ureterocele, or hydronephrosis, additional serial ultrasounds are usually recommended to follow the fetal kidneys. A prenatal consultation with a pediatric urologist, who is a specialist in newborn kidney and urinary tract surgery can be arranged through the Fetal to Newborn Care Center.
After birth, your child’s doctor will order an ultrasound of the urinary tract. During this exam, harmless sound waves bounce off organs and tissues to help the doctor see the structure and function of the urinary tract.
Another common test is the voiding cystourethrogram (VCUG), a procedure in which the child’s bladder is filled with a special fluid. As he or she urinates, the doctor can observe the urine flow and watch for reflux.
If the doctor suspects a child has a duplex kidney, a cystoscopy may help with examination of the urinary tract via a tiny light and camera.
How are ureteroceles treated?
Treatment before birth is not currently available. Treatment after birth depends on the size of the ureterocele, kidney problems and the general health of your child. The Fetal to Newborn Care Center’s team of specialists reviews each case to determine an individualized treatment plan. A nurse navigator helps to coordinate care and answer any questions from the family
After delivery, your pediatrician may prescribe low-dose antibiotics for your newborn to reduce the chances of a urinary tract infection. If the ureterocele is small and no kidney problems are diagnosed, the doctor will want to examine and test your child every few months as an outpatient. No hospital stay is necessary.
If the ureterocele appears large or there is evidence of significant kidney dilation, surgery may be necessary to drain the ureterocele. A cystoscope is inserted into the urinary tract and the ureterocele is punctured, causing it to deflate. The process usually takes less than 30 minutes to complete, and the child can often go home the same day.
When open surgery is required, it involves either removing the ureterocele and reattaching the ureter to the bladder or possibly attaching the dilated ureter to the normal sized one. Since this is a full operation, a hospital stay is required.
As the problems resolve, the chance for urinary tract infections may continue; thus, antibiotics may be prescribed for some time.
When a child has reconstructive surgery to reattach the ureters, ultrasounds may be used to monitor kidneys for proper growth and drainage.
How will ureteroceles affect my baby?
The good news is that with appropriate care, the vast majority of children with ureteroceles grow to be healthy and without long-term kidney problems.