Unilateral double ureter with urethrocele masquerading ureterocele — case report
Shih-Chang Fuh1, Meng-Lin Chang2, Shao-Yu Lin2
1Department of Urology, Taoyuan General Hospital, Taoyuan, Taiwan
2Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan.
Ureterocele is a cystic out-pouching of the distal ureter into the urinary bladder, and sometimes it may have ectopic insertion into urethra with associated duplicated collecting system.
Urethrocele is a focal out-pouching of the urethra. Urethrocele and ureterocele share some same symptoms, such as urinary incontinence, urinary frequency and recurrent infection. It is difficult to differentiate urethrocele from ureterocele by symptom. The gold standard of diagnosis is image study. We present a case of urethrocele with ureteral duplication, mimicking the presentation of ureterocele in both symptoms and image study.
A 38-year-old woman presented to our department with recurrent urinary tract infection and urinary incontinence. She had multiple clinics visited with different diagnosis, such as uterine prolapse, bladder prolapse or ectopic ureterocele. Pelvic exam revealed a protruding, soft mass over anterior vaginal wall. Urinanalysis showed mild microscopic hematuria. Intravenous pyelography disclosed duplication of left collecting system. Cystourethroscopy showed small opening over urethra. MRI revealed fluid acumination over peri-urethral lesion. Due to the annoying urine leakage and recurrent infection episode, surgical intervention of drainage was first applied. Then excision operation was then arranged. After surgical treatment, no more urinary incontinence was reported by the patient.
Several theories have been proposed to explain the etiology of female urethral ureterocele. Most urethrocele are acquired. Potential theorized causes of acquired urethrocele include vaginal birth trauma, urethroscopy, urethrotomy, and various open surgical procedures. However, most widely accepted theory implicates repeated infections of the periurethral glands with subsequent obstruction eventually evolving into urethrocele. Congenital urethrocele is rare. Due to the embryonic origin of distal urethra and ureter, congenital urethrocele have been postulated to arise from congenital dilatation of periurethral cysts, association with blind ending ureters. Thus, congenital urethrocele may be difficult to be differentiated from ureterocele, physician should be alerted.