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Urinary Tract Infection (UTI)

Normally, each kidney has two ureters that drain urine from it and into the bladder. At times, certain factors can result in the ureter to close down and obstruct the normal flow of urine. Ureterocele is caused when the opening of the ureter closest to the bladder becomes larger in comparison to the opening of the ureter and results in obstruction of urine flow from the kidney into the bladder. Let us learn some more about the condition to determine its ideal treatment.


What happens in Ureterocele?
 

As part of the urinary tract, kidneys function to filter the blood and remove waste, salt and water from it. This produces urine in the kidneys which is then transferred out through the one-way valve at the opening of the ureter and into the bladder.

When a person is affected by ureterocele, it is usually seen as a congenital defect (birth defect) which affects the kidneys, bladder and the ureter. In this condition, the portion of the ureter connecting to the kidney tends to swell and block the comparatively smaller ureteral opening which obstructs the normal flow of urine.


There are mainly two types of ureteroceles:

  • Ectopic – When the portion of the ureter protrudes from the bladder outlet and into the urethra.

  • Orthotopic – When the ureterocele is completely inside the bladder.

Ureterocele mostly causes a type of kidney infection. Vesicoureteral reflux which occurs when the urine flows back into the kidney is commonly seen in individuals with dual ureters connected to the kidney.


What are some symptoms of ureterocele?

Normally, ureterocele do not show any visible symptoms but the symptoms when seen are:

  • Flank/back pain

  • UTI (urinary tract infection)

  • Fever

  • Painful urination

  • Foul-smelling urine

  • Abdominal pain

  • Blood in urine

  • Excessive urination


How is a ureterocele diagnosed? 

Normally, ureteroceles are observed during prenatal ultrasound testing. A common test for detecting UTI also helps to detect this condition mostly.
Generally, the doctor will use ultra-sonography imaging test for the initial evaluation.

VCUG (voiding cystourethrogram) test, an advanced type of x-ray test, helps detect abnormalities in the bladder and the lower urinary tract.
The doctor may also advise to check the functioning of the kidneys as well. A renal scan is efficient for this purpose.


What are some treatment options for Ureterocele? 

There are several types of treatments used for ureteroceles. The exact treatment is dependent on several factors, such as the age of the patient, the functioning level of the affected portion of the kidney and the presence of vesicoureteral reflux condition. At times, the doctor may advise a combination of two or more treatment techniques for complete treatment of the ureteroceles.


The common treatment methods for ureteroceles include:

  • Transurethral puncture: This is a minimally invasive surgical treatment which mainly punctures the ureterocele before decompressing it using a cystoscope inserted through the urethra. This is a small surgical treatment method and is performed as an outpatient surgical procedure.
    This treatment is best-suited for cases where the ureterocele is entirely inside the bladder (orthotopic).

  • Upper pole nephrectomy: This treatment method is used in cases where the upper half portion of the kidney is affected and stops to function normally. There is also a lack of vesicoureteral reflux. In such cases, it is advised to remove the affected portion of the kidney. This procedure is often performed using minimally invasive laparoscopic surgical methods.

  • Nephrectomy: In case the entire kidney stops to function due to the ureterocele, the doctor will recommend removing the kidney altogether. This is also performed using advanced minimally invasive surgical methods (laparoscopic surgical technique).

  • Removal of the ureterocele and ureteral reimplantation: In case the condition requires removal of the ureterocele this is the best-suited treatment method. The surgeon will remove the ureterocele and reconstruct the floor and neck of the bladder. The ureters are also re-implanted efficiently to prevent vesicoureteral reflux between kidney and bladder.

  • Ureteropyelostomy or upper-to-lower ureteroureterostomy: In case the upper part of the affected ureter is still working effectively the doctor may either connect the obstructed upper portion to the clear lower portion of the ureter/pelvis of the kidney.


Frequently asked questions: 

Is there any way to prevent this condition? 

There is no known prevention for this condition; it is present at birth but may not be discovered until later in life. 


My baby was diagnosed with a ureterocele on a prenatal ultrasound. She seems very healthy. Is it absolutely necessary for her to undergo treatment? 

In the past, most children with a ureterocele had their condition detected following a serious kidney infection, which often required hospitalization for intravenous antibiotics. Consequently, it would be unusual for her not to develop a urinary tract infection unless her ureterocele was treated.

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