亞東紀念醫院 外科部 泌尿外科
Repeat Acute Pyelonephritis Caused by an Ureterocele:
A Case Report and Literature Review
Shang-Ju Hsieh, Chung-You Tsai, Shiu- Dong Chung, Shyi-Chun Yii
Division of Urology Department of Surgery, Far Eastern Memorial Hospital, New Taipei City
Introduction: Ureterocoele is a congenital anomaly that affects females more than males. The most common complication of ureterocoele is obstructive uropathy leading to upper urinary tract infection and/or kidney damage. Once the ureterocoele is asymptomatic, observation without prophylactic antibiotics is acceptable. However, if a patient suffers from symptomatic ureterocoele, surgical intervention is warranted. Transurethral incision of the ureterocoele is a safe and feasible management technique for symptomatic ureterocoele. This case demonstrates the clinical findings of the ureterocoele and the typical imaging features, including bladder echography, abdominal computed tomography (CT), and cystoscopy.
Case report: A 36-year-old woman presented to our outpatient clinic with a complaint of right flank pain for one day. Her history indicated that she had been suffering from repeat acute pyelonephritis for the past one year. During physical examination, she expressed pain on the right side from costovertebral angle tapping, but no other specific findings were noted. Laboratory results showed neutrophilic leucocytosis (WBC 11.340/μl, neutrophils 84%), and urine analysis revealed pyuria (WBC 48.7/HPF). Renal echography showed grade II hydronephrosis on the right side, and bladder echography revealed a 2-cm cystic lesion near the right ureter orifice. No urolithiasis was noted from the plain abdominal radiograph. An abdominal CT scan was performed to exclude radiolucent calculi, which revealed a right ureterocoele and several hypodense areas in the right kidney, suggesting concurrent acute pyelonephritis. After discussing with the patient, a mono-polar transurethral incision of the ureterocoele was performed without complications. Right-side rigid ureteroscopy showed dilatation of the lower ureter just above the ureterocoele and hydronephrosis. A double- J catheter (Ureteral Stent InLay® Double Pigtail 6Fr 24-cm Hydrophilic Coated) was placed for temporary stenting. Renal echography showed no hydronephrosis two weeks later, and the DBJ was removed. The patient recovered well and did not experience urinary tract infections in the following three months.