罕見之輸尿管囊腫併脫垂：病例報告暨文獻回顧

陳子双¹、沈元琦¹

¹高雄長庚紀念醫院 泌尿科

Prolapsed Ureterocele causing bladder outlet obstruction: A case report and literature review

Tzu-Shuang Chen¹, Yuan-Chi Shen¹

¹Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

Introduction:

Ureterocele is a congenital cystic dilatation of distal ureter and it remains a challenge to diagnose and treat in adults. We herein report a case of ureterocele concurrent with prolapse causing bladder outlet obstruction in an adult woman.

Case presentation:

A 62-year-old woman had history of urethral prolapse status post mid-urethral sling procedure and abdominal total hysterectomy at other hospital. However, the protruding mass from meatus causing voiding difficulty persistent even after the surgery and the mass can be manually reduced back by herself. She went to our emergency room complaining of a mass at the perineum unable to bed reduced back and aggravated voiding difficulty with urine leakage for days. The physical examination showed a 5x5 cm congested, tense and tender mass at the perineum, protruding from urethra. Due to the impression of bladder eversion from urethral meatus and possibility of ischemic change, we sent her to operation room immediately. Under general anesthesia, cystoscopy was performed firstly and revealed meatus over ventral site favoring bladder posterior wall prolapse. Bilateral ureteral orifices were identified with urine efflux upon examination of the everted bladder. The right one was below meatus and the left one was near previous bladder neck site. Then meatotomy was done and the everted bladder was reduced manually. After surgery, we arranged Computed Tomography urography (CTU) to survey the anatomy of her upper urinary tract and pelvis. It revealed a cystic lesion about 4x5.6 cm in right ureterovesical junction favoring ureterocele and mild bilateral hydronephrosis with more prominent over right side may associated with her impaired renal function (eGFR=50 mL/min/1.73m²). Cystoscope examination confirmed left side mild ureterocele and right side severe ureterocele. Video urodynamic study showed no obvious vesicoureteral reflux during filling or voiding and an intravesical filling defect descend while terminal voiding with outlet obstruction. She underwent an endoscopic resection of the wall of ureterocele (transurethral unroofing). Finial pathological report showed mucosa chronic inflammation with squamous metaplasia. After the endoscopic surgery, she has smooth voiding and no more prolapse from meatus till the 1 month follow-up.

Conclusions:

Prolapsed ureterocele is a rare event and few literature mentioned previously. In our case, reduction of mucosa tissue first and then resection of the ureterocele by endoscopic method resolve the condition successfully.