Ureteric valve: Case report with an insight into anatomy, embryology, presentation and management

Abstract

Congenital ureteric obstruction caused by a ureteric valve is an exceedingly rare entity. Our patient, a nine-year-old male, had undergone evaluation for recurrent pain in the abdomen and was diagnosed as a case of left hydronephrosis on ultrasound abdomen. Intravenous urography and magnetic resonance urography showed incomplete duplex system on the right side along with left hydronephrosis and hydroureter. Cystoscopy with left ascending gram followed by excision of lower third of ureter along with valve and Cohen's ureteroneocystostomy was done. Histopathology revealed Type II ureteric valve. A high index of suspicion is required to make a correct preoperative diagnosis.

Double trouble: diagnostic dilemma in a rare association of proximal ureteric valve with orthotopic ureterocele—case report

“…Rabinowitz has classified ureteric valves as Type I or Type II, based on the presence of smooth muscle within the leaflet or at the base only [5]. Morphologically, ureteric valves can be classified as cusp-like (leaflet) and diaphragmatic or annular type [1]. Our case was an annular type II ureteric valve, as demonstrated by histopathology.…”

“…Ureteral valves are a rare clinical finding. Frequently, they are associated with other urological anomalies such as complete or incomplete renal duplication, ectopic ureter, vesico-ureteral reflux and horseshoe kidney [1,2]. Hydronephrosis is the most common clinical sign.…”

Congenital ureteral valve as a diagnostically challenging congenital ureteral defect

“…The diagnostic criteria were proposed in 1952 by Wall and Wachter and include: • presence of transverse folds of the ureteric mucosa containing bundles of smooth muscle fibre; • no other evidence of mechanical or functional ob struction; • signs of obstructive disease above the valve with a normal ureter below it (2)(3)(4) . Another classification was proposed by Rabinowitz (3,4) : • type I -smooth muscle present within the folds; • type II -smooth muscle at the base only. Morphologically, three types of ureteral valves can be distinguished: cusp-like, diaphragmatic and annular type (3) .…”

“…Another classification was proposed by Rabinowitz (3,4) : • type I -smooth muscle present within the folds; • type II -smooth muscle at the base only. Morphologically, three types of ureteral valves can be distinguished: cusp-like, diaphragmatic and annular type (3) . The pathophysiology is still unknown.…”

“…It is believed that the valve may be a persistence of Chwalla's membrane or arise as a result of disturbances during embryogenesis (2,3,5) . Valve location in the ureter has been described as 50% in the proximal part, 17% in the middle third, and 33% in the distal third (3)(4)(5) . Cases of bilateral valve have also been reported (2) .…”