Ureterocele: symptoms, causes, and treatment & bull; hello healthy

Definition

What is a ureterocele (ureterocele)?

Ureterocele (ureterocele) is a birth defect in which the bottom of the ureter near the bladder swells up like a balloon. The ureters are the tubes through which urine flows from the kidneys into the bladder. The ureterocele makes the ureteric opening narrow, which blocks the flow of urine.

Based on its position, ureterocele is divided into different types, namely intravesical and extravesical. Intravesical ureterocele is a swelling that is located on the inside of the bladder. This is also called an orthotopic ureterocele.

Meanwhile, extravesical ureterocele swelling appears in the neck of the bladder and infiltrates the urethral tract. Another name is ectopic ureterocele.

There are also other types named cecoureterocele. In this condition, swelling occurs below the neck of the bladder and reaches into the urethra, the tube through which urine flows from the bladder to be excreted from the body. This type is one that is rarely encountered.

How common is this condition?

This condition is more common in women than men. Its presence is most often detected when a person is under two years of age. However, it is possible that there are adults who also have ureteroceles.

Ureterocele is also more common in people with duplex kidneys. Duplex kidney is a condition in which one part of the kidney has two ureteral channels at once, whereas normally each kidney only has one ureteral tube.

Signs and symptoms

What are the symptoms of a ureterocele?

Usually people with this condition have no symptoms. New symptoms appear when the condition is accompanied by other diseases such as urinary tract infections. If there are symptoms, the things that the patient will generally feel are:

• abdominal pain,
• back pain,
• severe pain on the side of the body and can reach the thigh, groin, and genital area,
• bloody urine,
• hot sensation when urinating (anyang-anyangan), and
• frequent urination.
• A lump in the stomach
• Unusual smelling urine
• Difficulty urinating

In some cases, the patient may also experience fever as one of the symptoms.

When to see a doctor?

If you or your child has experienced the symptoms above, consult a doctor immediately to get the right treatment. Untreated urine blockage can lead to an infection that can damage the kidneys.

Cause

What causes ureterocele?

The exact cause of this condition is not yet known because ureterocele is basically a birth defect. An explanation of the cause is only to find out how the symptoms appear.

The kidneys work by filtering and removing waste and excess water from the blood to produce urine. Later, urine will flow from the kidneys through small tubes called ureters into the bladder.

When a person urines, the urine in the bladder is excreted through the urethra, which is the tube at the bottom of the bladder.

In people who have a ureterocele, urine cannot flow properly into the bladder because of the swollen end of the ureter. As a result, urine builds up in the ureter and can increase in size if the amount of urine is too much.

Ureterocele also causes urine to flow backward from the bladder to the kidneys, this is known as reflux. Reflux can cause symptoms such as urinary tract infections in the form of fever, painful urination, and the urge to urinate constantly.

If the swelling is from the bottom of the bladder to the urethra, the result is that the patient will have difficulty passing urine.

Complications

What complications can occur?

Complications that can occur due to ureterocele are pyelonephritis (kidney infection) and impaired kidney function. The blockage of urine will later interfere with the working kidneys so that the ability of the kidneys to filter will be reduced.

In addition, ureterocele can also trigger urinary tract infections that can recur at a later date.

Diagnosis

How to diagnose a ureterocele?

Ureterocele can be diagnosed before the baby is born through an ultrasound procedure (USG). This procedure can also show swollen ureters or kidneys. However, generally this condition is only diagnosed after birth and if the child has problems related to urination.

To see any complications from a UTI, the patient will be asked to do a urine test. In addition, here are various other tests that may also be carried out.

Voiding cystourethrogram (VCUG)

The VCUG test is an X-ray scan that is done to see how well the bladder is working. Later, the doctor will insert a special solution that is injected through a tube called a catheter from the urethra into the bladder.

After the bladder is filled, a device called a fluoroscopy will take pictures and show the presence or absence of a ureterocele.

MAG III kidney scan

This procedure is done to see how the kidneys are functioning and to determine the severity of the blockage. Doctors use an intravenous (IV) line to inject a special solution called an isotope into a vein. Isotopes serve to clarify the picture of the kidneys.

The scan is done when the ureterocele has been found, as an additional check to confirm any damage to the kidneys resulting from this condition.

MRI

When the above procedures have not shown completely clear results, the doctor may also order an MRI scan. Using a combination of magnets, radio frequency, and a computer, an MRI will show a more detailed picture of the kidneys, ureters, and bladder.

Treatment

What are the treatment options for ureterocele?

Treatment for ureterocele can vary from person to person. The treatment procedure chosen will certainly be adjusted to the patient's age and health. In addition, the doctor will also see if the patient has reflux and whether kidney function is affected.

Sometimes in some cases, the patient also needs more than one procedure. Here are the various options.

Antibiotic drugs

If the ureterocele is detected before the baby is born, the doctor may prescribe a low dose of prophylactic antibiotics. Antibiotics are used to fight bacteria. Antibiotics are also given to patients who have urine reflux problems to prevent infection.

Operation

Apart from taking antibiotics, surgery can also be chosen as a way to treat ureteroceles, especially if the size of the swelling is larger and interferes with urination activities. The types of surgery include:

• Endoscopic surgery. Surgery is performed by inserting a device in the form of a lit tube called cystoscope. The instrument is inserted into the bladder through the urethra, which will then pierce the swollen ureterocele. This procedure usually does not require hospitalization and lasts 15-30 minutes.
• Ureter implantation. Ureter implantation involves removing the ureterocele, then putting the ureter back in its original place. In addition, this procedure will also repair the bladder neck to increase urine flow. The procedure can be performed via minimally invasive surgery using a laparoscopic or robotic approach.
• Upper polar nephrectomy. This procedure is performed if the ureterocele is accompanied by a duplex kidney condition or if the upper part of the kidney is not functioning properly. If the kidney has two ureters and only one of them is damaged, the damaged part will be removed, leaving one healthy ureter. Often this surgery is done through a laparoscopic approach by making a small incision under the ribs.

Care after surgery

After performing the surgical procedure, the patient still has to perform a number of treatments to ensure that the patient's condition remains good.

Whether the patient is undergoing endoscopy or reconstructive surgery, the doctor may refer the patient to an ultrasound of the kidneys to see if the kidneys are functioning properly and the ureterocele has completely disappeared. Later, the patient will still have to take antibiotics for some time according to the doctor's recommendations.

Most ureterocele patients, especially children, can grow up healthy and normally without long-term kidney problems. However, you still have to keep an eye out for any problems that might arise in the future.