雙側輸尿管囊腫併輸尿管積水：超音波、靜脈腎盂攝影和膀胱鏡檢查發現

鄭偉權、康智雄

高雄長庚紀念醫院泌尿科

Case report: Bilateral ureterocele with left hydroureter: Finding on ultrasound, intravenous pyelogram, and cystoscope.

Wei Quen Tee, Chih-Hsiung Kang

Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Introduction

        Ureteroceles represent a cystic dilation of the distal aspect of the ureter that is located either intravesical or extravesical. Ureteroceles may be associated with a single or duplex system, and duplex systems are associated with the upper pole. We presented a rare case report of bilateral ureterocele with clear image examination.

Case report

        A 36 years old man denied any systemic underlying disease. He suffered from incomplete emptying for months and voiding intermittency. He denied fever, dysuria, frequency, urgency, and gross hematuria. He was transferred to our hospital due to a bladder lesion noted during the bladder ultrasound examination. Urine analysis showed within normal limits. Transabdominal urinary bladder ultrasound showed a cystic lesion over the left trigone. Fiberocystoscopy showed left orifice persistent bulging mass lesion and right orifice bulging mass when urine passage, bilateral ureteroceles were noted. Intravenous pyelogram showed bilateral ureteroceles, more prominent over the left side with urine stasis caused hydroureter. Blood test renal function within normal limits.

        Due to LUTS symptoms (incomplete emptying and voiding intermittency) may be caused by some degree of obstruction and left hydroureter, we performed bilateral transurethral incision of the ureteroceles. The left ureterocele was incised and resected the roof of the ureterocele. The right ureterocele was incision via the right orifice when bulging. The patient was tolerant of the whole procedure without complication.

Discussion

        Most ureteroceles are detected through prenatal ultrasound imaging, even if only through the identification of hydronephrosis. Bladder outlet obstruction by a ureterocele can occur and may be manifest as hydronephrosis and possible obstruction of all renal units. Presentation of ureteroceles in teens or adults has been reported, usually associated with infection or abdominal pain and rarely incontinence. Our patient had lower urinary tract symptoms may be due to a large ureterocele causing a sensation of incomplete emptying and partial bladder outlet obstruction.

       The goals of management are preservation of renal function; elimination of infection, obstruction, and reflux; and maintenance of urinary continence. There are open procedures and endoscopic management for ureterocele. It depends on the size of the ureterocele, the degree of obstruction, the function of the kidney, and other factors. In an open procedure, ureterocele excision and ureter reimplantation could be performed. In endoscopic management, transurethral incision or multiple punctures of ureterocele showed no difference in decompression rates, although multiple punctures induced less reflex into the affected ureter.

Conclusion