奇美醫療財團法人奇美醫學中心 外科部 泌尿科
An Adult Male Ureterocele Combines with Complicated Stone: A Case report and Literature Review
I-Chen Tsai, Kau-Han Lee, Chien-LiangLiu, Steven K. Huang
Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;
Purpose: Ureterocele is a cystic dilatation of the lower part of the ureter. It is contributed to congenital anomaly such as a duplicated system or other diseases. The symptom presentation varied with different type of ureterocele. The incidence rate is 1 in every 4000 individuals. Here we presented an adult case with impacted stone in the ureterocele with severe hydronephrosis
Case presentation: This 62-year-old Taiwanese male denied any systemic disease. Under his routine health exam, right lower third ureteral stone with hydronephrosis was found. The abdominal CT was arranged and revealed impaction stones about 2 cm in the right ureterovesical junction with severe hydronephrosis. Another 2cm right renal stone was also noted at lower calyx. He underwent endoscopic operation under general anesthesia. Transurethral unroofing of the ureterocele followed by stone fragmentation and retrograde intrarenal surgery of the renal stone. The following dynamic renal function study showed diminished right renal split GFR 25.3 ml/min compared to left side 32.1 ml/min. The patient is planning to arrange VCUG and uro-tract echo after JJ stent removal three months later.Conclusions: The pathogenesis of ureteroceles is not well understood. The classification was also varied due to the different age and presentation of the ureterocele. Identified the type of ureterocele help to apply appropriate managements. The classification included Stephens classification which depends on the size and location of the ureteric orifice, and Churchill classification based on the functional part. The American Academy of Pediatrics is more frequently used which classifies ureteroceles to intravesical (orthotopic) ureterocele or ectopic. Adult ureterocele is usually asymptomatic but it may coexist with other conditions such as a ureteral calculus, and in these conditions, it can be managed endoscopically. Long term follow up is required to monitor for hydronephrosis and iatrogenic vesicoureteral reflux.