Assessment of Obstruction in Adult Ureterocele by Means of Color Doppler Duplex Sonography

Abstract

Aim: The purpose of this study is to present a method for identifying a ureteral obstruction in unilateral orthotopic ureterocele by means of conventional sonography and color Doppler duplex sonography. We focus on the measurement of the ureterocele dimensions, the degree of dilation it causes to the ipsilateral upper urinary tract, the registration of urine out-flow from the ureteral orifice into the bladder and its spectral analysis. Material and Method: Over 2 years at our institutions, 8 adult patients (7 women, 1 man) were diagnosed as having a single system orthotopic ureterocele. Four of them presented with lumbar pain, dysuria and recurrent urinary tract infections, while the remainder were asymptomatic and diagnosed accidentally. The diagnosis was based on serial sonography of the upper and lower urinary tract confirmed by intravenous pyelography and cystoscopy. We also performed color Doppler duplex sonographic evaluation of the urine jets ejected from both ureteral orifices into the bladder. Using the flow spectral study we analyzed the waveforms and measured their duration and flow rate. The study was completed with a comparative analysis of the data obtained from both ureteral orifices. Results: Cystic dilation of the lower ureteric extremity into the bladder was presented in all cases. Upper urinary tract dilation, of various grades, was present in 4 of 8 patients. Differences in urine jets between those derived from the ureterocele and those from the healthy contralateral ureteral orifice were significant in those patients with dilation of the upper urinary tract. The differences concerned mainly the frequency and symmetry of the jets as well as the pattern, duration and velocity of their waves. The 4 above-mentioned patients, with dilated upper urinary tracts and waveforms differentiated from the contralateral ones, were characterized as obstructive. On the other hand, the remaining 4 patients with subclinical ureterocele showed insignificant differences in urine jets and waveforms, and were found to be non-obstructive. Conclusion: Conventional sonography of the urinary tract in combination with color Doppler duplex sonography of the ureteral jets can be used in an attempt to diagnose and evaluate a unilateral orthotopic (single system) ureterocele and assess the necessity of intervention to identify the obstruction.

Incidental Findings During Routine Antepartum Obstetrical Sonography

“…Ureteroceles, with a reported incidence of 0.8 to 2 per 10,000 liveborn infants, are often ectopic and associated with duplex systems. 90 In adults, the condition is rare and frequently asymptomatic, 91 but prolapse may occur, resulting in urethral obstruction 90,92 and subsequent renal failure due to hydronephrosis. 93 With infection, the obstructed system may lead to sepsis.…”

“…94 More common complications of ureteroceles in adults include dysuria and recurrent urinary tract infections. 91,95 In pregnancy, urinary tract infections can cause complications, including polyhydramnios, amnionitis, preeclampsia, intrauterine growth retardation, fetal sepsis, and premature birth.…”