techroki.com – A ureterocele (ureterocele) is a birth defect in which the lower part of the ureter close to the bladder swells like a balloon. The ureters are the tubes through which urine flows from the kidneys into the bladder. Ureterocele makes the ureteral opening narrow so that it will block the flow of urine.
Based on their position, ureterocele is divided into different types, namely intravesical and extravesical. An intravesical ureterocele is a swelling located on the inside of the bladder. This is also known as an orthotopic ureterocele.
Meanwhile, swelling of the extravesical ureterocele appears at the neck of the bladder and infiltrates the urethra. Another name is ectopic ureterocele.
There is also another type called cecoureterocele. In this condition, the swelling occurs below the bladder neck and reaches into the urethra, the tube through which urine flows from the bladder to be expelled from the body. This type is one of the rare ones.
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 old. However, it is possible that there are adults who also have ureterocele.
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Ureteroceles are also more common in people with duplex kidneys. Duplex kidney is a condition where one part of the kidney has two ureters at the same time, whereas normally each kidney only has one ureter.
What are the symptoms of a ureterocele?
Usually people with this condition have no symptoms. New symptoms appear if the condition is accompanied by other diseases such as urinary tract infections. If there are symptoms, the things the patient will generally feel are:
- stomach pain,
- back pain,
- severe pain on the sides of the body and can reach the thighs, groin, and genital area,
- bloody urine,
- hot sensation when urinating (anyang-anyangan), and
- frequent urination.
- Lump in stomach
- Unusual smelling urine
- Difficulty urinating
In some cases, patients may also experience fever as a symptom.
When should you see a doctor?
If you or your child has experienced the above symptoms, immediately consult a doctor to get the right treatment. Urinary blockages that are not treated can raise the possibility of infection that can damage the kidneys.
What causes ureterocele?
The exact cause of this condition is not known because basically ureterocele is a birth defect. An explanation of the cause is only to find out how the symptoms may 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.
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When a person urinates, the urine in the bladder is expelled 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 accumulates in the ureters and can expand in size if there is too much urine.
Ureterocele also causes urine to flow backwards from the bladder into the kidneys, this is known as reflux. Reflux is what can cause symptoms such as urinary tract infections in the form of fever, pain when urinating, 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.
What complications can occur?
Complications that can occur due to ureterocele are pyelonephritis (kidney infection) and impaired kidney function. Blockage of urine will later interfere with the kidneys that are working 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.
How to diagnose ureterocele?
Ureterocele can be diagnosed before the baby is born through an ultrasound (USG) procedure. This procedure may also reveal swollen ureters or kidneys. However, this condition is generally only diagnosed after birth and if the child has problems related to urination.
To see any UTI complications, the patient will be asked to do a urine test. In addition, here are various other tests that may also be performed.
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.
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Once the bladder is filled, an instrument called 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 kidney.
The scan is done when a ureterocele has been found, as an additional test to confirm any damage to the kidneys caused by this condition.
When the above procedures have not shown 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.
What are the treatment options for ureterocele?
Treatment for ureterocele can vary from person to person. The treatment procedure chosen will of course be adjusted to the age and health of the patient. In addition, the doctor will also see if the patient has reflux and whether kidney function is affected.
Sometimes in some cases, patients also need more than one procedure. Here are the various options.
If a ureterocele is detected before the baby is born, the doctor may prescribe a low dose of prophylactic antibiotics. Antibiotics are used to fight bacteria. Antibiotic drugs are also given to patients who have urinary reflux problems to prevent infection.
In addition to taking antibiotics, surgery can also be chosen as a way to treat ureterocele, especially if the swelling is larger and interferes with urination. Types of surgery include:
- Endoscopic surgery. Surgery is performed by inserting a lighted tube called a cystoscope. The tool is inserted into the bladder through the urethra, later this tool will puncture the swelling ureterocele. This procedure usually does not require hospitalization and lasts 15-30 minutes.
- Ureteral implantation. Ureteral implantation involves removing the ureterocele, and then the ureter is put back in its original place. In addition, this procedure will also repair the bladder neck to increase urine flow. The procedure can be performed through minimally invasive surgery using a laparoscopic approach or with a robot.
- Upper pole 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 ureter still healthy. Often this operation is performed via a laparoscopic approach by making a small incision under the ribs.
Care after surgery
After performing the surgical procedure, the patient still has to do a number of treatments to ensure that the patient’s condition remains good.
Whether the patient underwent endoscopy or reconstructive surgery, the doctor may refer the patient for a kidney ultrasound to see if the kidney is 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 advice.
Most ureterocele patients, especially children, can grow healthily and normally without having long-term kidney problems. However, you still have to keep an eye on any problems that might arise in the future.