病例報告: 經尿道膀胱鏡輸尿管囊腫切除手術及相關文獻討論

張君愷、李經家

高雄醫學大學附設中和紀念醫院 泌尿部

Case report: Transurethra resection of intravesical ureterocele and literature review

Chun-Kai Chang, Ching-Chia Li

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

A ureterocele is a cystic dilatation of the terminal ureter within the bladder and/or the urethra. It may present as an incidental finding on antenatal ultrasonography, or postnatally because of symptoms due to urinary tract infection (UTI) or obstruction. A ureterocele occurs in about 1 in 5000 to 1 in 12000 children and most commonly seen in the Caucasian population. Females are 4-7 times more commonly affected than males. Bilateral ureteroceles are seen in 10% of cases only. Most ureteroceles are congenital, usually associated with the ectopic insertion of the ureter with associated duplicated collecting system. In a minority of cases, ureteroceles are an isolated abnormality, and these are usually seen in adults.

Our case was a 43-year-old male who had urolithiasis history. He had suffered from painless gross hematuria for one month and then came to our outpatient department for help. Abdomen echo showed hypoechoic lesion over bladder. Then cystoscopy was arranged and revealed huge cystic lesion over bladder. Intravenous urography was done and demonstrated an ovoid lesion with contrast filling in the urinary bladder at right ureterovesical junction. Cobra head sign was noted and highly suspected right ureterocele. Transurethra resection of ureterocele was done smoothly. One ureter stone was also found in ureterocele, we also disintengerated it by laser. No obvious urinary tract symptoms was noted after operation.

Surgical treatment is needed in most cases. Options range from endoscopic correction to complete open reconstruction. The choice of surgical intervention is dependent upon the clinical setting, particularly if there is a duplex or single system, and the presence or absence of VUR. Since the introduction of endoscopic procedures in the 1980s, the most common surgical intervention has been to endoscopically incise the ureterocele.